OEFI selects HealthEdge's HealthRules product suite

Sep 8 2010

HealthEdge, provider of the only modern, enterprise-class software platform for healthcare payors, today announced that the Pasadena, Calif.-based Operating Engineers Funds Inc. (OEFI) has selected the patented HealthRules product suite to tackle the non-profit health plan's unique and challenging service needs. An independent professional benefits administrator operating under the Taft-Hartley labor act, OEFI administers the employee benefit programs of the International Union of Operating Engineers (IUOE), Local 12, and its dependents and beneficiaries, including more than 35,000 heavy equipment operators, mechanics, concrete pumpers, soil testers, inspectors, and surveyors.

“HealthRules will enable us to handle a great deal of change with very little effort”

According to Fund Manager Mike Graydon, "After struggling for years with an outdated claims processing system, our Trustees were looking for a proven, next-generation healthcare technology platform that would serve us well both now and into the future. We did not want to face yet another major system overhaul in a few years when the next set of healthcare standards are adopted," Graydon continued, "and we were focused on finding a system that was designed to be implemented quickly and with less risk than other available offerings. After a rigorous evaluation and selection process, we found that HealthRules was the only product available that met both of these criteria."

"Our use of the HealthRules platform," Graydon continued, "will enable us to enter into more sophisticated agreements with our insurance carriers, which is something that will benefit both OEFI and our members. Based upon the results of our early testing with the HealthRules products, for example, we expect to realize as much as $4 million in potential savings from one of our large insurers as a result of the significant reduction in turnaround time that we will be able to achieve."

With an in-house, legacy system that had been extensively modified, finding a platform that could quickly and easily address the complexity of the existing OEFI plans and contracts, while at the same time enabling the company to offer a wide variety of new products based on the rapidly evolving needs of their members, was a top priority. HealthEdge proved that it could meet these needs by quickly configuring many of OEFI's most complex benefit plans and contracts. "HealthEdge's performance during our evaluation was so impressive," added Graydon, "that OEFI staff made a unanimous recommendation to the Board of Trustees to purchase the HealthRules suite within a week of its completion."

HealthRules' language-based technology provides organizations like OEFI with real-time configurability and a level of flexibility that can accommodate even the most complex plan and contract designs. These capabilities were a decisive factor in OEFI's selection process, because they will enable OEFI to quickly and easily address the continuously evolving needs of their members using in-house resources. "HealthRules will enable us to handle a great deal of change with very little effort," said Graydon, "and it will allow us to instantly provide a wealth of information that will aid our Trustees and their advisors in terms of both planning and decision making."

"As organizations like OEFI search for technology that will allow them to more effectively compete in the new healthcare marketplace," said Rob Gillette, CEO of HealthEdge, "more and more of them are recognizing the unique capabilities that are part of the award-winning HealthRules product suite. We are thrilled to have OEFI as a customer, and we are looking forward to helping them achieve their goals using the HealthRules platform."