Bain Capital Merges HealthEdge and UST HealthProof to Transform Payer Technology

Bain Capital has completed the acquisition of UST HealthProof from UST and merged it with HealthEdge, creating a comprehensive technology platform for health insurance companies. The combined entity, which will operate under the HealthEdge name, now serves more than 115 health plans representing over 110 million covered lives across the United States.

The merger follows Bain Capital's earlier acquisition of HealthEdge from Blackstone in a deal valued at $2.6 billion, including debt, which closed in June. Financial terms of the UST HealthProof acquisition were not disclosed. Kevin Adams, the former CEO of UST HealthProof, now serves as CEO of the combined company.

The consolidation brings together HealthEdge's software solutions for claims processing, care management, payment accuracy, provider network management, and member engagement with HealthProof's interoperability platform designed to modernize legacy systems. The integrated platform addresses critical challenges facing health plans, including rising administrative costs, complex regulations, and increasing member expectations.

"We now have an end-to-end ecosystem that satisfies 95% of the back office needs of a health insurance company," Adams told Fierce Healthcare. The executive emphasized that the merger creates opportunities for significant operational improvements through native AI integration rather than adding AI capabilities on top of existing systems.

The combined company plans to leverage artificial intelligence to transform claims processing, which Adams described as a complex transaction involving convoluted data. "Processing claims is a very difficult, complicated transaction, and if we can apply even modest AI benefits into there, we can rapidly get to touchless transactions within claims and that's a nirvana of health insurance," he said.

Adams projected substantial efficiency gains from the merger, noting that the combined capabilities could reduce operational costs by approximately 30% for health insurance companies. "I'm not talking about cost takeout by doing lots of layoffs. I'm talking about cost takeout in terms of making things much more effective and efficient," he clarified.

The companies have a nine-year history of partnership, with UST HealthProof being one of HealthEdge's largest customers prior to the merger. "We have worked hand-in-glove together to tackle the cost issues within health insurance for the past nine-plus years. What HealthEdge built, we added on to with our own intellectual property and capabilities, partnered with our deep services knowledge. We are health plan operators, and HealthEdge is a health plan software provider. When you put those two things together, you now have an end-to-end capability to completely transform how health insurance is delivered in the United States," Adams explained.

Paul Moskowitz, a partner at Bain Capital, described the combination as creating a "next-generation cloud-based claims system for payers, with the scale, expertise and technology to disrupt the sector." With Bain Capital's backing, HealthEdge plans continued investment in AI and data capabilities, targeting improvements in risk stratification, revenue integrity, and core operational efficiency.

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