Innovation at HealthEdge: Past and Future

The journey of transforming healthcare starts with innovation. At HealthEdge, customers can expect transformational business and IT solutions that drive superior business outcomes.

For more than 15 years, HealthEdge has helped customers of all sizes and lines of business transform their organizations, innovate, successfully compete, and achieve breakthrough results.

It all started at the inception of HealthEdge in 2005 with HealthRules Payor®. Our flagship core claims administration solution introduced the unique English-like HealthRules Language®, which transforms the benefit-plan design, network design and contracting process, and makes claims processing faster and easier, while delivering high auto-adjudication rates, high accuracy, and unprecedented transparency. HealthRules is a next-generation platform, recognized by Gartner, KLAS, and other reputable analyst groups.

In 2020, HealthEdge extended its offerings with the acquisition of Source to add claims payment accuracy, pricing, and editing capabilities to our existing offerings. With the acquisition of GuidingCare®, HealthEdge obtained the most successful modern care management platform in the marketplace. This year, we welcome Wellframe and its digital health management capabilities to the family.

Our growth and innovation timeline has led us to serve nearly 100 health plan customers with a combined solution suite that touches over 35 million covered lives across all lines of business. And we’re not stopping anytime soon. Together, HealthRules Payor, Source, GuidingCare, and Wellframe empower customers to effectively compete, improve healthcare quality, and be resilient to changes in the healthcare marketplace. The integrated ecosystem offered by these products moves customers closer to offering a full digital experience to their members.

Looking forward, HealthEdge is focused on three areas of innovation: efficiency in business processes and workflows; increased automation through analytics and machine learning; and creating an application partner ecosystem through API access and data exchange with the HealthEdge application platforms.

We are also committed to a digital-first experience for health plans that complements the composable future-state of the healthcare IT ecosystem. To keep up with digital disruption in the healthcare industry, payers need intelligent, next-generation solutions. Payers who do not invest in next-generation technology will likely be left behind.

As HealthEdge continues to grow, refine our solutions and integrations, and build out partner relationships, health plans can trust that HealthEdge will remain a leading innovation partner with a renewed focus on customer success. I am excited to see where 2022 and the coming years will take us.

About the Author

Sanjeev Sawai

Sanjeev Sawai, Chief Innovation Officer, HealthEdge

Sanjeev Sawai is Chief Innovation Officer at HealthEdge. He is passionate about applying technology to solve challenging business problems in the payer ecosystem. Over the years, Sanjeev has led the development of many innovative products in several markets: financial services, natural language speech applications, defense and embedded systems. He led product development for HealthRules Payor prior to taking on this role at HealthEdge.

Learn More about Sanjeev

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