Advantasure and the art of closing the gap

The instruction is wonderfully specific: look for the yellow paper. In a 2021 tip sheet for Mount Carmel Health Partners, Advantasure’s clinical documentation alert arrives with three possible answers. Yes, the condition was addressed. No, it does not exist. Or it exists, but was not addressed today. An elaborate healthcare business has come down to a form and a decision.

The form matters because an insurer’s understanding of a patient depends on what survives the journey into the medical record. Advantasure occupied that awkward territory between knowing something and getting it recorded, submitted or acted upon. Its product included software, coders, coordinators and people making phone calls.

One gap. Three answers.

Mount Carmel’s instructions make an essential distinction. Checking yes requires supporting documentation showing monitoring, evaluating, assessing or treating the condition. Checking no is appropriate when a condition has resolved or never existed. A checked box without support can trigger a query after review. The alert itself is not the official medical record.

This is the practical core of risk adjustment: helping the documented picture reflect the patient’s actual conditions. A diagnosis gap concerns that picture. A care gap concerns a service still needed. Advantasure offered services spanning both, but the two should never be casually treated as interchangeable.

Consider Premera’s 2020 preventive-care campaign. Advantasure agents called selected Medicare Advantage members, explained overdue services and offered scheduling help. Provider offices were told to expect three-way calls. Analytics might identify the opportunity; a person still had to get the appointment into the calendar.

The back office comes with people

That combination explains the company better than the label SaaS. Advantasure supplied enrollment, billing and claims technology alongside outsourced operations. A North Dakota insurance examination records NextBlue’s January 2020 agreement covering claims, premium billing, enrollment, correspondence, portals, health management, and appeals and grievances. These were working responsibilities inside an insurance plan.

Its historical product range also included risk adjustment analytics, medical-record retrieval and review, encounter-data submission support, and quality programs. Symphony covered case, disease and utilization management. The EDPS platform formatted, validated, reconciled and tracked submission files. The appeal was breadth: a buyer could seek technology and operational help across several linked functions.

Advantasure’s market position sat between an administrative software supplier and a specialist risk-and-quality services firm. Its distinction was the combination of those jobs and government-program experience. For a plan evaluating it, the sensible comparison was the total work required across vendors, internal staff and interfaces.

Teach the people writing the code

The same preference for embedding expertise appeared in engineering. A Veracode case study describes security analysis integrated into Advantasure’s development pipeline, supported by developer education and designated security champions. Rather than expecting a small security group to teach every developer individually, the company put advocates inside development teams.

“we have ambassadors that can evangelize secure coding”

Sue McTaggart
Application Security Architect, Advantasure

The case study reports faster remediation of severe flaws and quicker deployment, without publishing a numerical improvement. The transferable idea is concrete: train people near the work, automate the checks and rank the findings so developers can act. This approach needs time for training and authority to fix problems; scanning alone cannot supply either.

The sale had an accounting shadow

Advantasure’s corporate history complicates the smooth integration pitch. Visiant and Tessellate combined in 2018; Premera told providers about the Advantasure name in January 2019. UST HealthProof announced its purchase agreement in September 2022 and completed the acquisition in March 2023, naming Robert Hillman president.

The buyer’s release emphasized expanded risk-and-quality capabilities. The seller’s financial statements tell another part of the story. Blue Cross Blue Shield of Michigan recorded a $314 million gross loss when Advantasure and Tessellate were written down for sale in 2022. The completed 2023 sale generated $23 million in net proceeds and another $1 million pretax loss.

Those figures describe the combined disposal and its accounting, rather than the cost of a customer implementation. They show that assembling capabilities can carry substantial financial consequences. The public record supports the strategic rationale for the acquisition; it does not establish a private moment when executives changed their minds.

The name changed. The handoffs remained.

In September 2024, UST HealthProof brought Advantasure and Advalent under its own brand. One year later, Bain Capital acquired UST HealthProof and merged it with HealthEdge. The combined business took the HealthEdge name, with Kevin Adams as CEO. Its announced reach of more than 115 health plans belongs to that combined company.

For readers assessing the business today, that succession matters. A historical Advantasure product list describes where capabilities came from. A current purchase needs a current demonstration of what is integrated, who delivers it and how responsibility moves between teams. One company name cannot answer those questions by itself.

Copy the follow-through

The useful lesson is to follow one task all the way through. Ask how a flagged condition becomes supported documentation. Ask who helps arrange a preventive visit. Ask who resolves a rejected file. A convincing demonstration should include an exception and the person responsible for clearing it.

That is also the limit of the proposition. Provider participation, usable records and dependable operations are necessary conditions. Put weak handoffs behind a single interface and they remain weak handoffs. Advantasure’s most instructive artifact is still that yellow sheet: a modest device that insists someone decide what happened, then make the record agree.