HealthEdge and UST HealthProof Merge to form Healthcare Payer Technology

HealthEdge and UST HealthProof announced the successful close of their merger, following Bain Capital’s acquisition of UST HealthProof from UST. Financial terms of the transaction were not disclosed.

Headquartered in Boston, the combined company will operate as HealthEdge. With its significant reach into the U.S. healthcare system, touching over 110 million lives, HealthEdge is well-positioned to empower health plans with modern AI-enabled technology and services that lower total costs and improve operational efficiency. The combined company will also be supported by Bain Capital’s forty-plus years of experience building and adding value to healthcare companies around the world to drive innovation and improve patient experiences and outcomes.

Health plans are under pressure from rising administrative costs, more complex regulations, and growing member expectations, and legacy systems are not serving plans’ evolving needs. The combination of HealthEdge and UST HealthProof creates a single, end-to-end platform that helps payers modernize their operations. By uniting HealthEdge’s AI-powered payer applications with UST HealthProof’s interoperability suite, the platform streamlines administrative processes, lowers total costs, and improves the member experience. UST HealthProof’s proprietary technology also reduces the risks of migrating to the cloud, giving payers a safer path to digital transformation while supporting better clinical outcomes for both payers and patients.

Top Ambitions for this Joint Venntures

The combined company brings together award-winning technology, end-to-end product breadth, and industry experience to accelerate payer technology modernization. In particular, the combined company will:

·Drive improved value for payersthrough integrated software and tech-enabled services, that can lower total costs while improving clinical outcomes

·Unlock new product and market expansion opportunitiesin a growing industry

·Accelerate platform and services innovation, by developing an AI-native operating system that supports all aspects of the payer value-chain, from claims administration automation and payment integrity to personalized member engagement

·Create a stronger, unified go-to-market presence to address customers’ greatest needs

HealthEdge will be led by a management team that leverages leadership, vision, and expertise from both legacy organizations, creating new opportunities for team members to learn and grow. Kevin Adams, the former CEO of UST HealthProof, will serve as CEO of the combined company. Steve Krupa, the former CEO of HealthEdge, will remain actively involved as a member of the company’s board of directors.

“I’m honored to take the helm at this pivotal moment for healthcare technology,” said Kevin Adams, CEO of HealthEdge. “Health plans are looking for new ways to handle rising costs and regulatory demands while meeting what their members expect. This merger brings together best-in-class payer technology with seamless integration capabilities and experienced operational teams. It streamlines the administrative complexity that health plans deal with every day. Our integrated approach gives them a solution that’s easier to implement and more effective in delivering the value they are seeking.”

“HealthEdge has successfully partnered with health plans for years to drive continuous innovation in healthcare IT,” said Steve Krupa, member of HealthEdge’s Board of Directors. “We’re now positioned to unite modern technology with proprietary interoperability and proven operational expertise — enabling health plans to deliver a future of frictionless and cost-effective healthcare experiences.  We’re excited to join forces with UST HealthProof to deliver even greater value to our customers and teams.”

“HealthEdge and UST HealthProof are two innovative businesses with complementary customer bases, product suites, and go-to-market engines that combined will create the first end-to-end, next-generation claims platform of its kind for payers. And they have a proven track record of partnering with each other for nearly 10 years to create compelling value for health plans,” said Devin O’Reilly, a Partner at Bain Capital.

“By bringing these two leaders together, we are creating the clear next-generation cloud-based claims system for payers, with the scale, expertise, and technology to disrupt the sector. With healthcare at a critical inflection point and payers under unprecedented financial pressure, the combined company is well positioned to lower costs, harness AI-driven innovation, and deliver the frictionless US healthcare experience of the future,” said Paul Moskowitz, a Partner at Bain Capital.

TripleTree acted as financial advisor, Kirkland & Ellis LLP as legal counsel, and Ares Management as lead financing partner to Bain Capital. Evercore acted as financial advisor to HealthEdge. Goldman Sachs and JPMorgan acted as financial advisor and Davis Polk & Wardell LLP as legal counsel to UST HealthProof.