HealthEdge “State of the Payor” Industry Survey Shows Insurers Turning To Next-Generation Technology To Transform Their Organizations

Research highlights the reasons behind this adoption, including the significant impact of the Affordable Care Act

Burlington, MA, December 11, 2014 —HealthEdge®, provider of the only integrated financial, administrative and clinical platform for insurers, today announced the latest results from its “State of the Payor” industry survey. The data revealed that an overwhelming majority of insurers are planning to use technology to address the challenges and opportunities of today’s healthcare marketplace.

“More than 88 percent of executives surveyed are embracing technology as the catalyst to transform their organizations as they work to lower costs, address new market opportunities and improve outcomes,” said Ray Desrochers, executive vice president at HealthEdge. “This is in direct response to the limitations of outdated legacy systems, which have been holding insurers back for years, and shows that leveraging next-generation technology is the only choice for payors seeking to compete in the new healthcare economy.”

According to the results, insurers continue to struggle with low auto-adjudication rates, the high cost of manually-adjudicated claims and a reliance on manual business processes. Respondents cite these as the top reasons behind their need to adopt new technologies and modernize their business operations. For example, 87 percent of respondents cited automating existing manual business processes as the primary factor in lowering administrative costs. More than 56 percent of respondents are currently auto-adjudicating less than 80 percent of their claims, and more than 57 percent are paying more than $6 to manually adjudicate a claim.

Additionally, the significant impact of the Affordable Care Act on insurer organizations was also evident, with more than 87 percent of survey respondents citing this legislation as the primary factor influencing their decisions to participate in new healthcare business models. Among these new models, respondents cited public and private Exchanges (73 percent), Pay-for-Performance (73 percent), Medicare & Medicaid expansion (67 percent), Accountable Care Organizations (62 percent) and Value-Based Benefits (51 percent) as the models they will participate in or support over the next three years. 

Conducted twice per year, the “State of the Payor” industry survey benchmarks the views of insurance executives on topics including upcoming business imperatives, technology investments and market trends. More than 120 leaders from health plans across the United States participated in the online survey. To request the full results or learn more information about the survey, please visit

About HealthEdge

HealthEdge® provides modern, disruptive technology that delivers for the first time, a suite of products that enables healthcare payors to leverage new business models, improve outcomes, drastically reduce administrative costs and connect everyone in the healthcare delivery cycle. Our next-generation enterprise product suite, HealthRules®, is built on modern, patented technology and is delivered to customers via the HealthEdge Cloud or on-site deployment. An award-winning company, HealthEdge empowers payors to capitalize on the innovations, challenges and opportunities that await in the new healthcare economy. For more information, visit