Government

Government-sponsored healthcare programs now account for the majority of healthcare spending in the United States. While serving that market may be an attractive opportunity, succeeding in it can be a challenge. Health plans seeking to pursue Medicare, Medicaid and dual eligibles lines of business need to excel at delivering care, controlling costs, ensuring regulatory compliance and supporting the shift to value-based care models.

HealthEdge® healthcare government plans software gives you the tools and resources you need to succeed at all of the goals.

Picture shows male and female healthcare professionals in a discussion about government-sponsored healthcare programs
Medicare

In the competitive Medicare market, HealthEdge solutions help ensure quality care, ease the shift to value-based care, support compliance and lower costs.

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Medicaid

Overcome the complexity and fragmented engagement of Medicaid care with HealthEdge solutions that support care, control costs and ensure compliance.

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Dual-Eligibles

Our dual eligibles solution suite enhances claims processing with payment integrity and feeds data to an end-to-end care management solution. Together, they enable better compliance, lower costs, higher-quality care and improved outcomes.

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How HealthEdge
Can Help

HealthRules® Payer

Gain the ability to expand into new markets and quickly stand up and grow all lines of business. The platform's reusable configuration capabilities drastically reduce IT and administrative costs and improve operational efficiency.

Source

Choose the only prospective payment integrity solution that natively delivers up-to-date regulatory data, claims pricing and editing, and real-time analytics tools in a single IT ecosystem. With higher visibility into the overall payment management process, you can strategically grow your government line of business.

GuidingCare®

Turn to the nation's largest and most widely adopted platform for care management and population health to address care coordination, medical management workflow and regulatory compliance to serve any member.

Wellframe

Gain insights between clinical encounters and provide more consistent support. Wellframe Digital Care Management extends the reach of your staff to engage more fully with your high-risk members.

Source

Choose the only prospective payment integrity solution that natively delivers up-to-date regulatory data, claims pricing and editing, and real-time analytics tools in a single IT ecosystem. With higher visibility into the overall payment management process, you can strategically grow your government line of business.

GuidingCare®

Turn to the nation's largest and most widely adopted platform for care management and population health to address care coordination, medical management workflow and regulatory compliance to serve any member.

Wellframe

Gain insights between clinical encounters and provide more consistent support. Wellframe Digital Care Management extends the reach of your staff to engage more fully with your high-risk members.

HealthRules® Payer

Gain the ability to expand into new markets and quickly stand up and grow all lines of business. The platform's reusable configuration capabilities drastically reduce IT and administrative costs and improve operational efficiency.