HealthEdge Survey Shows Healthcare Payors Remain Burdened By Legacy Technology

“State of the Payor” industry survey finds continued interest in new business models, transparency, mobile and direct-to-consumer offerings, despite struggles with outdated technology and manual processes

Burlington, MA, September 25, 2013 — HealthEdge, provider of the only integrated financial, administrative and clinical platform for healthcare payors delivered via the HealthEdge Cloud or on-site deployment, today announced that findings from the latest “State of the Payor” industry survey show that payors continue to struggle with their outdated technology solutions as they explore new ways to compete in the rapidly evolving healthcare marketplace. The survey of more than one hundred healthcare industry executives from across the country confirms the growing desire among payors to evolve their businesses and adopt next-generation healthcare business models. At the same time, however, many respondents indicated that their existing systems will not effectively support new plan designs, payment reform approaches and increased organizational transparency requirements as well as a number of other key goals.

According to the survey, 78 percent of payors are seeking to expand participation in Medicare and Medicaid; 71 percent are exploring Pay-for-Performance (P4P) initiatives; and 61 percent desire to participate in Accountable Care Organizations (ACOs). Many payors, however, are not prepared to address the technological requirements of these new models. While payor interest in ACOs is high, 47.3 percent of respondents indicated that they do not have the technology that is required to support them. Similarly, 60.5 percent of respondents admitted that they do not have the technology that will be required to support next-generation Consumer-Directed Healthcare Plans (CDHPs) and another 52.4 percent face the same challenge when trying to support Value-Based Benefit Designs (VBBDs).

In addition to these findings, HealthEdge also learned that:

  • Many payors are planning to go beyond Health Insurance Exchanges (HIXs) and offer products directly to consumers
  • Payors are overwhelmingly looking at mobile tools to help connect everyone in the healthcare delivery cycle – particularly members and providers
  • Payors remain unconvinced that the 2014 deadline for ICD-10 compliance is the final date

“We are encouraged by our survey respondents’ interest in new healthcare business models, increased transparency, direct-to-consumer and mobile offerings and their strong desire to reduce unnecessary administrative costs,” said Ray Desrochers, executive vice president of Sales and Marketing at HealthEdge. “Unfortunately, as the survey results show, much work still needs to be done to ensure that payors are technologically ready to support these important new initiatives. Now is the time for payors to stop relying on legacy systems and costly manual processes. Payors need to leverage modern technology platforms to transform their businesses and compete in the new healthcare marketplace.”

To address new business models and other organizational goals, many payors are currently relying on costly manual processes to handle transactions that are not supported by their legacy systems. For a number of payors, this is proving to be a costly approach. For example, 55.4 percent of survey respondents indicated that they are automatically adjudicating less than 80 percent of claims, while at the same time 60.8 percent of survey respondents admitted that they are currently paying $6 or more to manually adjudicate a claim. Payors that leverage manual processes to deploy new business models risk getting trapped in a cycle of manual activity that may ultimately prevent them from successfully competing in this new healthcare economy.

Respondents to HealthEdge’s “State of the Payor” industry survey included more than 100 managers, directors and c-suite executives from health plans across the United States. To request the full results or learn more information about HealthEdge’s “State of the Payor” industry survey, please visit

About HealthEdge

HealthEdge® provides the only integrated financial, administrative and clinical software platform for healthcare payors delivered via the HealthEdge Cloud or on-site deployment. The HealthRules® platform, built on modern, patented technology, delivers for the first time, a suite of software products that enables payors to leverage new business models, improve outcomes, drastically reduce administrative costs and connect everyone in the healthcare delivery cycle. An award-winning company, HealthEdge delivers disruptive technology that makes the new healthcare economy work. For more information, visit