Market Brief

Core Administration

Industry changes are creating an imperative for health plans to transform the way they do business. What was once status quo has now become a dynamic, fast-moving landscape.


The shift to new business models, including those leveraging value-based payments and benefits, ACOs, public and private exchanges and growth in the Medicare and Medicaid segments all represent opportunities for health plans embracing change. In addition, the need to stay compliant in the face of evolving regulatory pressures and growing expectations by consumers of a customer experience similar to that provided by other industries present immediate and unique requirements to stay competitive. 

All this while striving to contain and lower both administrative and healthcare costs. 

According to Gartner, “The imperative to change demands a complete re-evaluation of payer industry business priorities, customers and competitors. Payer leaders — including not only CIOs, but also CEOs, CFOs and boards of directors — must adapt to new industry-wide forces right now.”* The ability to harness all available information, initiate proactive health actions and communications, provide an optimized customer experience and connect everyone involved in the healthcare delivery cycle in real-time, while at the same time controlling costs, is now critical for success.

For many health plans, outdated technology is causing expensive workarounds and manual processes that prevent a successful response to new business opportunities. The unavoidable reality is the need for a next-generation core administrative platform that can not only keep up, but also provide a unified solution for the future.

In a recent Voice of the Market Survey commissioned by HealthEdge and conducted by Survata, health plan executives identified member satisfaction as the top-ranked organizational goal for 2018. Those same executives selected “Modernize technology to enable resiliency to change” as the top priority to achieve their organizational goals. 

The most transformative health plans are using the award-winning HealthRules product suite from HealthEdge to drive new levels of agility, efficiency and transparency across their organizations, while simultaneously delivering superior customer experiences. Health plans implementing HealthRules have benefited from unparalleled flexibility, enabling them to quickly address market opportunities and stay in front of their competition. They have also achieved new levels of transparency and customer service as they are now able to provide accurate, real-time information to everyone involved in the care continuum. And those same health plans have achieved this while simultaneously automating their critical manual business processes, resulting in significantly lower administrative costs and an enhanced bottom line. 

Join the growing ranks of leading health plans transforming their place in the dynamic healthcare marketplace.


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*Business Drivers of Technology Decisions for Healthcare Payers 2018, Gartner