HealthEdge Research Shows Majority of Healthcare Payor Organizations Plan to Support New Healthcare Business Models in the

Company’s Market Survey Uncovers Payors’ Need for Modern Technology Platforms that will enable them to Successfully Operate in New Healthcare Marketplace

BURLINGTON, Mass.--(BUSINESS WIRE)-- HealthEdge®, provider of the only modern, enterprise-class software platform for healthcare payors, today revealed the results of its recent Payor Market Survey. The survey findings, based on responses from more than 100 leaders from payor organizations across the country, offer important insights into the current state of the industry, the challenges that many payors are facing as they try to compete in the new healthcare economy and their plans for the coming years.

The results of the survey clearly showed that while many payor organizations intend to participate in new healthcare business models including value-based plans, pay-for-performance and Accountable Care Organizations (ACOs), most do not have the technology in place that will be required to realize this goal. The study also revealed some of the most significant obstacles that payors face with regard to their current IT systems. These include numerous challenges related to the adoption of new standards and regulations, high rates of manual processing, out-of-control administrative costs and difficulty providing real-time access to critical business data.

When asked which healthcare delivery models their organizations planned to support over the next three years, 48 percent of the survey respondents indicated that they intend to leverage value-based benefit designs (VBBD), 55 percent said that they will participate in Accountable Care Organizations (ACO), and 51 percent indicated that they will utilize pay-for-performance (P4P) models. However, when asked which healthcare delivery models their organizations are ready to support today from a technology standpoint, the vast majority of the executives surveyed indicated that their organizations currently lacked the technology required to address these new business imperatives.

“We were impressed by the number of payor organizations that are planning to support one or more of the new healthcare business models within the next three years,” said HealthEdge CEO Rob Gillette. “The one-size-fits-all healthcare offerings of yesterday are being rapidly replaced by options that support new levels of individualization, personalization and customization, and new levels of risk-sharing between payors, providers and members. Given this reality, it is not surprising that the survey respondents clearly indicated the need for modern technology platforms that will enable them to successfully compete in the emerging 21st century healthcare economy. We look forward to continuing to play a major role in the market’s technology transformation.”

The executives that participated in the survey also shared some concerning feedback related to the industry’s ability to support the new ICD-10 coding standard. With less than two years to go until ICD-10 must be fully implemented, only 22 percent of the respondents surveyed felt that their organizations were “completely prepared,” while 36 percent listed their organizations as “somewhat prepared,” and 37 percent admitted that they were only “starting to prepare” for this important new standard.

“At this point, payors should be well on their way towards meeting ICD-10 mandates,” said Ray Desrochers, Executive Vice President of Sales & Marketing for HealthEdge. “Our survey instead revealed that many organizations are behind schedule, and many payor executives are struggling to address business needs while simultaneously trying to avoid pouring more money into the remediation of their outdated technology infrastructure. It is critical that payors make evaluating and remediating their IT systems a priority in 2012, so that they are ready to both meet the 2013 ICD-10 deadline and the other rapidly evolving needs of the new healthcare marketplace.”

To request a copy of the complete survey results, please visit

About HealthEdge

HealthEdge provides the only modern, enterprise-class software platform for healthcare payors. Using the patented, award-winning HealthRules software suite, health plans, health insurance companies and other payors can finally respond to new business opportunities and market changes in hours, not months or years, while drastically reducing both IT and operational costs. Leveraging an investment of over $150 million, HealthRules is the most modern, scalable and cost-effective technology in the industry. HealthEdge is the only choice for payors to survive and thrive in the emerging healthcare economy. For more information, visit


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