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The health insurance payer market has become more competitive in recent years, and with this added pressure comes increased complexities. New entrants in already saturated markets, like provider-sponsored health plans, increase competition as they attempt to gain market share with new value-based products and provider collaboration programs. Often, plans add new lines of business to capitalize on growing markets like Medicaid, Medicare Advantage or state-based marketplaces, but then must face the increased complexities of compliance requirements and fragmented sales channels. Even adding supplemental health offerings, like behavioral health and outsourced care, brings the new complexity to enrollment processes.

As a result, we are seeing some dynamic changes in the industry as health plans attempt to remain competitive. However, plans can gain a competitive advantage while actually mitigating complexities in a simple and undiscovered way – through enrollment optimization. Health plans with outdated enrollment channels and processes are inhibiting top-line revenue growth through costly process inefficiencies and a lack of integration or visibility across lines of business. By modernizing enrollment channels and consolidating all operations into a single Enrollment Hub, health plans can leverage existing infrastructure and IT investments into an efficient, streamlined enrollment process that maximizes top-line revenue and mitigates risk.


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Edifecs Inc. is a global healthcare software company committed to improving outcomes, reducing costs, and elevating the value of healthcare for everyone. Edifecs delivers the industry’s premier IT partnership platform to providers, insurers, pharmacy benefit management companies, and other trading partners. By mobilizing its leading solutions at the front end of the healthcare information pipeline, Edifecs provides a unified platform for partners to flexibly pilot and scale new initiatives using their existing enterprise systems. Since 1996, hundreds of healthcare customers have relied on Edifecs partnership solutions to future-proof their leading initiatives in the midst of a dynamic healthcare landscape. Edifecs is based in Bellevue, WA, with operations internationally. Learn more about us at edifecs.com.

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