Case Study: Innovative Regional Healthcare Company achieves scalable growth and integrated care management with HealthEdge

Empowering Innovative Healthcare with Integrated HealthEdge® Solution

The innovative regional healthcare company faced the challenge of integrating a newly acquired third-party administrator with an outdated, highly customized legacy system while simultaneously scaling to support its rapid growth and ambitious goal of reaching one million members. To overcome these obstacles and gain modern automation, AI capabilities, and developer enablement, the company selected HealthEdge and its HealthRules Payer and GuidingCare platforms as its next-generation core administrative and care management solutions.

HealthEdge implemented its integrated HealthRules Payer system for operational efficiency and scalability and the GuidingCare care management platform to provide a comprehensive view of members. This solution enabled the health plan to avoid a costly in-house build of its utilization lines of business, and provided the flexible, scalable technology infrastructure required to power its aggressive growth strategy and focus on whole-person care.