Case Study: a large digital health company scales member growth and care management with HealthEdge

Digital Health Improves Care Transitions For Members With Multimorbidities

A large digital health company faced significant challenges in scaling its innovative health plan after a major acquisition. Its rapid growth, outdated systems from the acquired TPA, and the need for automation and AI-driven efficiency drove the search for a modern core administrative processing system. The health plan turned to HealthEdge for a solution to integrate its acquisition, support expansion, and build new lines of business.

HealthEdge implemented its HealthRules Payer and GuidingCare platforms to create a seamless, scalable infrastructure. This solution provided the needed automation, machine learning capabilities, and a natively integrated care management system, which eliminated the need for an in-house build. By choosing HealthEdge, the health plan gained a flexible, next-generation system that supports its goal of expanding to one million members by 2027.