Our Solutions

Individual

Health plans that serve the individual market face particular challenges to stay ahead in today’s competitive and dynamic marketplace.

They need next-generation technology that offers flexibility, transparency and enables innovation so they can grow their business. HealthEdge's integrated solution suite provides health plans with the agility to quickly adapt and offer new products, improve operational efficiency, and deliver value to your customers.

Health plans with individual lines of business achieve greater levels of operational efficiency, lower costs, and deliver enhanced levels of transparency and customer service with HealthRules® Payor . Plans can keep pace with the innovation of exchanges by using standard integrations that enable accurate reporting and information exchange and are highly configurable for rapid implementation.

Case Study
Friday Health Plans: Building for Growth, Efficiency and a Consumer First Future

With HealthRules Payor, Friday Health Plans transformed into an agile, next-generation, modern organization that can keep up with shifting consumer demands. Download the one-page case study to learn how HealthRules Payor enabled Friday Health Plans to achieve outstanding customer experience metrics while scaling to meet lofty growth goals.

Burgess Source®'s unique workflow design manages all underlying data, processing, results, and business intelligence in a single instance to streamline operations. With the benefits of automated processes, payment accuracy, and real-time data, Burgess customers can spend less time on manual workarounds and devote more resources to developing affordable plans that meet shifting consumer demands. Burgess Source offers flexibility and can easily scale to include additional lines of business as the health plan grows.

Data Sheet
Burgess Source Analytics Advantages

Download the data sheet to learn more about Burgess Source Analytics capabilities that enable enterprise-wide decision support to set medical policy, renegotiate provider contracts, and identify and remediate billing and utilization trends within your provider network.

GuidingCare® supports any kind of member in any type of plan and can help health plans competing in the individual market streamline their care management. The software technology platform improves coordination among clinical, behavioral and community resources, and accelerates quality improvement and member engagement

Working together, HealthRules, Burgess Source, and GuidingCare enable health plans serving individual markets to tackle critical imperatives including:

  • Enrolling large numbers of new members successfully and accurately
  • Meeting the specific needs of individual members easily with a variety of rapidly configured plans
  • Increasing member satisfaction with the transparency of real-time information
  • Delivering a superior customer experience that retains members and increases engagement
  • Reducing administrative cost significantly by automating everything
  • Participating in exchange business profitably with the agility to adapt to changes quickly