Healthedge Survey Exposes Critical Technology Challenges Facing Healthcare Payors

Latest “State of the Payor” industry survey shows legacy technology solutions preventing the adoption of next-generation healthcare business models

Burlington, Mass. – January 15, 2013 –HealthEdge®, provider of the only integrated financial, administrative and clinical platform for healthcare payors, today announced that it has uncovered a number of important challenges that are impacting payors’ ability to meet the needs of the new healthcare marketplace. More than 170 executives from payor organizations across the country participated in HealthEdge’s latest “State of the Payor” industry survey, and they confirmed payors’ interest in leveraging and supporting a number of new healthcare business models.

Of the survey respondents, 68.8 percent plan to participate in accountable care organizations (ACOs), 65.6 percent in pay-for-performance initiatives (P4P) and 58.8 percent in models that leverage value-based benefits (VBBs) over the next three years. However, many of the same respondents highlighted that they do not have the platforms required to support these initiatives, as 41 percent indicated that they don’t have the technology needed for ACOs, 34 percent for P4P, and 47 percent for VBBs.

“Our survey showed a basic disconnect in the payor community between the payors’ desire and their ability to embrace next-generation healthcare business models,” said Ray Desrochers, Executive Vice President at HealthEdge. “With the future of health reform now coming into focus, driving renewed consumer involvement in healthcare, we believe that 2013 will be the year that many payors must focus on transforming their businesses through the use of cutting-edge technology. This will include replacing their outdated legacy systems and embracing modern technology platforms that will enable them to meet their 21st century business goals.”

Reliance on outdated technology platforms will also force many payors to continue to incur the massive administrative costs associated with manually processing significant numbers of claims. The “State of the Payor” survey showed that a quarter of the respondents manually process 40 percent or more of their claims. This manual effort, according to those surveyed, costs $6.00 or more per claim for approximately 65 percent of respondents, and more than $9.00 per claim for a full 10 percent of the participants.

Additional results of the survey will be released shortly. For more information, including the option to sign up to receive the latest survey statistics before they are announced, please visit

About HealthEdge

HealthEdge® provides the only modern, enterprise-class software platform for healthcare payors. Using the patented HealthRules® software suite, health plans, health insurance companies, and other payors can finally respond to new business opportunities and market changes in hours, not months or years, while drastically reducing both IT and operational costs. Leveraging an investment of over $150 million, HealthRules is the most modern, scalable, and cost-effective technology in the industry. HealthEdge is the only choice for payors to survive and thrive in the emerging healthcare economy. For more information, visit