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Better Together: HealthEdge + UST HealthProof Merge Under Bain Capital

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We are trusted allies of health plans and organizations, simplifying their complex operational and quality challenges across all lines of business

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Market leaders with a commitment to excellence in healthcare technology and outcomes

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Our team of dynamic thought leaders and innovators, driving transformative change in healthcare technology

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BPaaS Ecosystem

Integrated ecosystem of best-in-class, scalable, turnkey solutions for health plans across all lines of business

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Our BPaaS advantage

Move from the burden of fragmented legacy systems to scalability, efficiency, and predictable outcomes

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Core Administration

Suite of leading-edge core admin solutions designed to deliver outcomes with reduced costs across multiple lines of business

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SOLUTION GROUPS

Enrollment Plus™

Streamline enrollment processes and increase member satisfaction

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Engagement Plus®

Next best actions for data-driven personalized care

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Integration Plus®

Seamlessly integrate all your systems and data​

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Automate and optimize operations

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Operational insights, better and faster​

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Risk Adjustment

Proven technology and services solutions for health care plans and organizations, including Medicare Advantage

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Retrospective Risk Adjustment Solutions

Improve reimbursement accuracy, optimize gap and chase, and streamline submissions

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Prospective Risk Adjustment Solutions

Proactively close gaps at the point of care and maintain compliance

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Quality Improvement and Stars

Proven, tailored programs combined with strong industry expertise to help plans measure, analyze, and implement quality and Stars strategies with impact

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Stars Consulting Services

Pinpoint areas for improvement to maximize your Star potential

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Manage Quality performance with an end-to-end solution

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)

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Expert advisory services help optimize core health plan operations, reduce costs, enhance compliance, and drive improved member satisfaction and scalability.

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Core Administration

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Who we help

As market leaders with decades of domain experience, we engage with a diverse range of sector, from commercial, to private to government, across all lines of business

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Government-sponsored plans

Lower operating costs and improve outcomes with specialized solutions that meet regulatory requirements and member needs

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Commercial/Private plans

Improved efficiency and lower costs delivered through Core Administration, Risk Adjustment, Quality and Care Management Solutions

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Featured insights

BPaaS New Era Efficiency

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Next-generation BPaaS: A New Era of Efficiency for Health Plans

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Turning Gaps into Solutions: Advancing Provider Tools for Quality Care

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Why Mid-Size Payers are Uniquely Affected by Operational Inefficiency

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Why Mid-Size Payers are Uniquely Affected by Operational Inefficiency

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Integrated ecosystem of best-in-class, scalable, turnkey solutions for health plans across all lines of business

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Season 4

Move from the burden of fragmented legacy systems to scalability

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RADV Acceleration: What It Means for Medicare Advantage Plans

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EXPLORE CAPABILITIES

BPaaS Ecosystem Core Administration Risk Adjustment Quality and Stars

POPULAR SEARCHES

search Care Management search Core Administration search BPaaS search Risk Adjustment search Industry Insights search Client Success Stories search Quality & Stars
Whitepaper
Last updated: Oct 27, 2025

The Total Cost of Ownership Paradox

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Are administrative costs silently draining your health plan's profitability? With Administrative Loss Ratios averaging 12-15% of premium revenue, inefficiencies in claims processing, enrollment, and member services may be costing you more than you realize.

 

This white paper explores how health plans can break free from the cycle of reactive cost-cutting by adopting a strategic approach to Total Cost of Ownership (TCO). Discover how leading organizations are leveraging advanced assessments and AI-powered insights to identify hidden inefficiencies and unlock sustainable savings of 10-25% or more.

 

Learn about:

  • The true drivers of administrative overspend in core operations

  • A proven framework for transforming how you evaluate and optimize TCO

  • Real-world results from health plans achieving measurable cost reductions

  • How AI and machine learning are reshaping operational efficiency

 

Stop treating symptoms and start addressing root causes. Download this paper to learn how a comprehensive Core Administrative Value Discovery can help your organization reduce waste, improve member experiences, and fuel strategic growth.


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Insights

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BPaaS New Era Efficiency
Whitepaper
Next-generation BPaaS: A New Era of Efficiency for Health Plans
BPaaS
Doctor holding clipboard looking at screen
Whitepaper
Turning Gaps into Solutions: Advancing Provider Tools for Quality Care
Quality Improvement & Stars
Male Doctor and business woman walking up stairs
Whitepaper
Getting Risk Adjustment Right: A Guide for Modern Health Plans
Risk Adjustment

Let us help unburden your plan

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