HealthEdge Company Research Report

Company Overview

• Name: HealthEdge Software, Inc.

• Mission: To drive a digital transformation in healthcare through transaction automation and enable real-time business and clinical engagement among healthcare payers, providers, and patients. HealthEdge strives to usher in an era of digital payers characterized by improved member experience, reduced transaction costs, increased quality and service levels, and enhanced business transparency.

• Founded: HealthEdge was founded in 2005.

• Founders: No information is available about the specific founders.

• Key People:

• Stephen Krupa, Chief Executive Officer

• Matt McLaughlin, Chief Financial Officer

• Chris Conte, Executive Vice President & Chief Revenue Officer

• Anshul Pande, Executive Vice President & General Manager, HealthRules Payer

• Ryan Mooney, Executive Vice President & General Manager, Source

• Jacob Sattelmair, Executive Vice President & General Manager, Wellframe

• Dan Vnuk, Executive Vice President & General Manager, GuidingCare

• Michele Oliveto-Hill, EVP & General Manager, Global Professional Services

• Alan Stein, Chief Product & Strategy Officer

• Robert Duffy, Chief Technology Officer

• Heather Bender, Chief People Officer

• Craig Wilson, Executive Vice President & General Counsel

• Sandhya Gardner, MD, Chief Medical Officer

• Alex Saltzman, Senior Vice President, Corporate Development & Chief of Staff

• Jeannine Gaudreau, Chief Information Security Officer

• Headquarters: Burlington, Massachusetts

• Number of Employees: No information is available.

• Revenue: No specific revenue information is available.

• Known For: HealthEdge is known for its next-generation Core Administrative Processing System, HealthRules® Payer, which increases accuracy and efficiency for health plans while enabling digital transformation and innovation in healthcare operations.

Products

HealthRules® Payer

• Description: A digital, next-generation core administrative processing system designed to transform health plan operations.

• Key Features:

• Automation of claims processing

• Real-time data integration and business intelligence

• Supports complex health plan structures and configurations

GuidingCare®

• Description: A comprehensive care management workflow solution.

• Key Features:

• Care management and population health management

• Utilization management

• Integration with existing systems for efficient workflows and data management

Source

• Description: A prospective payment integrity solution focused on claim payment automation and business intelligence.

• Key Features:

• Payment accuracy tools for Medicare and Medicaid reimbursements

• Dynamic contract configuration for different lines of business

• Comprehensive editorial support for complex policy handling

Wellframe

• Description: Digital care management and customer service solutions aimed at improving member engagement.

• Key Features:

• Digitized care management processes

• Interpersonal healthcare connections through digital interfaces

• Real-time member insights to enhance healthcare experiences

Recent Developments

New Products and Features

• HealthRules Payer Named “Best in KLAS”: Awarded by KLAS Research for its claims administrative processing system for three consecutive years (up to 2024).

• Strategic Partnerships:

• Partnership with Edifecs for healthcare data exchange integration.

• Partnership with Zelis to streamline healthcare payments.

New Partnerships

• CitiusTech Integration: HealthEdge entered a strategic partnership with CitiusTech to enhance offerings for health plans.

• Blackstone Acquisition: In 2020, Blackstone, a leading investment firm, acquired HealthEdge and its subsequent acquisitions like The Burgess Group, Altruista Health, and Wellframe.

Recent Initiatives

• Launch of digital healthcare transformation solutions to improve operational efficiency, member engagement, and care management.

• Emphasis on integration capabilities and prospective payment integrity in addressing healthcare payer challenges and opportunities.

Each section of this report is meticulously compiled based on available data, focusing on HealthEdge's pivotal role in advancing digital healthcare systems.