Podcast: Current Trends for Payers - The Cost of Inaction

AI in Healthcare: Why Regulatory Momentum Is a Wake-Up Call for Health Plans 

Artificial intelligence (AI) is no longer a future consideration for health plans. AI-powered tools are already reshaping how organizations operate, how members seek information, and how leaders...

Funding the Mission: Reducing Administrative Waste in Risk Adjustment to Reinvest in Member Outcomes

Mastering CMS Compliance: Bridging X12 and FHIR 

Shifts in healthcare regulations continually push health plans to adjust their strategies. The Centers for Medicare & Medicaid Services (CMS) introduced sweeping mandates that fundamentally shift...

Podcast: Current Trends for Payers - The Hidden Economics of Payer Operations

CY 2027 Medicare Advantage Final Rule & Rate Announcement: 5 Updates Payers Need to Know 

With the recently released the 2027 Medicare Advantage Final Rule and Rate Announcement, The Centers for Medicare and Medicaid Services (CMS) confirmed it is finalizing payment rates at a...

RISE National 2026: A Turning Point for Risk Adjustment—and the Work Ahead 

This year marked the 20th anniversary of the RISE National Conference, but the milestone felt less like a retrospective and more like a clear signal of where health plan risk adjustment is heading...

4 Ways Home and Host Plans Stay Ahead with Next-Generation CAPS 

Health plans with home and host capabilities have set the standard for healthcare excellence since 1929—but mounting industry pressures constantly challenge these market leaders. Decreasing...

Real-Time Risk Adjustment in 2026: Modernizing Medicare Advantage Programs

Risk adjustment programs are entering a new phase of maturity. Historically, health plans approached Medicare Advantage risk adjustment retroactively, reviewing charts after...

Ethical AI: Privacy and Security

This is part 1 of a blog series on Ethical AI. This content was adapted from an internal learning and development session developed by HealthEdge’s AI team, focused on educating our organization...

Services Spotlight: Product Training is the Missing Link in Core System Implementations 

When health plans modernize their core administrative systems, the conversation often centers on technology. Implementation timelines, configuration decisions, and integrations dominate planning...