HealthEdge Software today said it is excited to upgrade long-time Altruista Health customer Colorado Access to a fully integrated ecosystem with the addition of HealthRules Payor® (HRP) to its operations via HealthEdge’s complementary Business Process as a Service (BPaaS) partner, UST HealthProof, a UST company. Colorado Access has relied on Altruista’s GuidingCare® care management platform to manage plan members for more than a decade, and is now poised for a major transformational effort to integrate the HealthEdge solution in core administrative processing. It will be one of the first health plans to adopt all three HealthEdge solution suites as it adopts Burgess Source® payment integrity software in 2022.
“Colorado Access is one of the first of many health plans we expect to recognize the value of our fully integrated core/clinical solution going forward. The unique value proposition that comes with integrating a health plan’s three most important value streams is becoming more apparent every day as plans push forward with value-based care.”
Steve Krupa, HealthEdge Chief Executive Officer
HealthRules is the leading modern core administrative system for health plans driving more agility, efficiencies, compliance and innovation than any other solution on the market. The vision for an integrated payer “digital nervous system” became possible with the HealthEdge acquisitions last year of SaaS innovators, The Burgess Group and Altruista Health. Burgess offers a leading payment integrity solution for editing, pricing and modeling. Altruista leads the industry in utilization management, care management, population health, social determinants of health, provider collaboration, member engagement and predictive analytics.
The new opportunity for Colorado Access came at contract renewal time for their incumbent provider of a core administrative processing system. The health plan found the prospect of moving to an integrated ecosystem intriguing.
“When we learned about the acquisition of Altruista Health by HealthEdge at the end of 2020, we were excited,” said Paula Kautzmann, Chief Information Officer at Colorado Access. “This presented a great opportunity to explore what an integrated ecosystem could deliver for us, our members and providers.”
“We serve our regional health plans with high quality, and our connected technology with the HealthEdge solution suite is a comprehensive yet cost-effective solution that reduces the need for customization and is proven to increase customer engagement and provider satisfaction,” said Raj Sundar, President, UST HealthProof.
Colorado Access has used GuidingCare to close gaps in care, enhance quality and compliance, and automate clinical workflows on behalf of its 545,000 members since 2010. After a review, Colorado Access concluded they could achieve cost savings, better performance, streamlined operations and a better member experience in moving to an integrated model with HealthEdge.
“We are really excited about the integration because it makes us more nimble,” said Kautzmann. “It gives us a way to leverage a 360-degree view of the member to more completely understand their needs and support them to optimal health. When our care management team see claims data in the care management environment, it gives them a chance to make preventive interventions that can improve a member’s health.”
Kautzmann noted that there are cost savings and overall efficiencies with integration, including not having to maintain separate membership, provider and benefit systems. The payment integrity solution from Burgess also reduces the administrative burden associated with recovering provider overpayments. In an environment of rigorous public budgets, the new arrangement is a better deployment of resources.
Colorado Access also opted to implement the new GuidingCare® Authorization Portal, which electronically streamlines the prior authorization process and eases the paper work burden between providers and the plan. Altruista introduced the Authorization Portal last year, generating sufficient utilization review data for one plan to actually reduce its list of services requiring preauthorization, reducing administrative burden and cost. Some 80 percent of services are auto-approved with the electronic tool, dramatically streamlining the process at the same time it aligns care with the world’s leading clinical guidelines.
About Colorado Access
As the largest and most experienced public sector health plan in the state, Colorado Access is a nonprofit organization that works beyond just navigating health services. The company focuses on meeting members’ unique needs by partnering with providers and community organizations to provide better personalized care through measurable results. Their broad and deep view of regional and local systems allows them to stay focused on our members’ care while collaborating on measurable and economically sustainable systems that serve them better.
HealthEdge offers the health insurance industry’s leading next-gen solution suit providing automation and seamless connectivity between all parts of a payer’s administrative and clinical systems. HealthEdge provides modern, disruptive healthcare IT solutions that health insurers use to leverage new business models, improve outcomes, drastically reduce administrative costs, and connect everyone in the healthcare delivery cycle. Its next-generation enterprise solution suite is built on modern, patented technology and is delivered to customers via the HealthEdge Cloud or onsite deployment. In 2020, funds managed by Blackstone became the majority owner. HealthEdge and its portfolio of mission-critical technology assets for payers, including Source® and GuidingCare®, are collectively driving a digital transformation in healthcare.
About UST HealthProof
UST HealthProof, a UST company, is on a mission to reduce administrative cost and play a role in shaping how the future of healthcare is delivered through consumer centricity. Our proven core admin solutions and business process-as-a-service (BPaaS) provide transparency, improve operational efficiency, break down operational barriers to scale and drive strategic growth.