2022 Best In KLAS Risk Adjustment

Perception

Optum/Change Healthcare Merger

16 August 22 | Boyd Stewart and Sam Eaquinto

In January 2021, Optum announced their intentions to acquire Change Healthcare. The merger remains unfinalized, however, as the US Department of Justice blocked the deal in February 2022 due to anticompetition concerns—such a merger would give UnitedHealth Group, Optum’s parent company and the nation’s largest insurer, access to rivals’ sensitive data. The legal proceeding is ongoing and scheduled to go to trial August 1, 2022. This report shares Optum and Change Healthcare customers’ reactions to the merger and their perceptions of its impact. Between March 2021 and April 2022, KLAS interviewed 48 individuals from 46 unique organizations; of these respondents, 9% are Optum customers, 56% are Change Healthcare customers, and 35% are customers of both vendors.

Analytics and risk adjustment are hot topics due to the expenses associated with value-based care, government regulations, and CMS programs. Pareto Intelligence’s revenue integrity solution attempts to provide organizations with actionable data to improve their risk documentation outcomes. This report examines the Pareto customer experience.

Vatica Health provides dedicated clinical support and technology to payers’ contracted physicians to improve diagnostic coding, documentation, and quality of care for members. Vatica Health’s team works on-site to lend providers support, enabling payers to manage members and their care while also increasing financial impact and reducing compliance risk.

Company/solution	Overall performance score (100-point scale)	Total evaluations	Trend (2021-2022)	Culture	Loyalty	Operations	Product	Relationship	Value

EXL Clarity™	93.2	n=15	0%	A	A	A-	A	A+	A

Apixio HCC Identifier	91.2	n=23	-3%	A	A-	A	B+	A	A+

Pareto Intelligence Risk Solutions	90.5	n=16	N/A	A	A	B+	B+	A	A

MedInsight Risk Analytics	89.6	n=23	+11%	A	A	B+	B+	A-	A-

Episource Risk Adjustment and Analytics	87	n=20	N/A	B	A-	B+	B	B+	A-

Datavant (Formerly Ciox Health) Ciox Health Risk Adjustment Solution	81.8	n=19	-4%	B-	B	B-	B-	B	B

Change Healthcare Risk View (Risk Analytics)	78.6	n=12	N/A	C+	C+	B	C	B	B

Inovalon ONE Platform Risk	60	n=16	N/A	F	D	D	D	D+	F
	50.0	100.0

Company/solution	Trend (2021-2022)	Culture	Loyalty	Operations	Product	Relationship	Value

EXL Clarity™ 93.2 n=15 COMMENTS	0%	A	A	A-	A	A+	A
Apixio HCC Identifier 91.2 n=23 COMMENTS	-3%	A	A-	A	B+	A	A+
Pareto Intelligence Risk Solutions 90.5 n=16 COMMENTS	N/A	A	A	B+	B+	A	A
MedInsight Risk Analytics 89.6 n=23	+11%	A	A	B+	B+	A-	A-
Episource Risk Adjustment and Analytics 87 n=20 COMMENTS	N/A	B	A-	B+	B	B+	A-
Datavant (Formerly Ciox Health) Ciox Health Risk Adjustment Solution 81.8 n=19 COMMENTS	-4%	B-	B	B-	B-	B	B
Change Healthcare Risk View (Risk Analytics) 78.6 n=12 COMMENTS	N/A	C+	C+	B	C	B	B
Inovalon ONE Platform Risk 60 n=16 COMMENTS	N/A	F	D	D	D	D+	F

Company/solution	Overall performance score (100-point scale)	Total evaluations	Culture	Loyalty	Operations	Product	Relationship	Value

Advantmed ELEVATE Risk Adjustment Insights * L	77.3	n=6	C+	C	C	B-	B-	B+

Arcadia Arcadia.io Arcadia Risk Navigator Plus * L	84.5	n=6	B	A-	C+	B	B	B+

Cotiviti Risk Adjustment Solutions * L	70.4	n=8	D+	C-	D+	D+	C-	B+

Optum Risk Adjustment Solutions * L	65.9	n=6	D+	D	D	D	C+	C-

Vatica Health Risk Adjustment and Quality of Care Solution * L	89.2	n=6	A	A	B	B-	A+	A

Veradigm Pulse8 Illumin8 Risk Analytics * L	72.9	n=7	C+	D+	C+	C+	B-	C

Company/solution	Overall performance score (100-point scale)	Total evaluations

Advantmed ELEVATE Risk Adjustment Insights * L culture C+ loyalty C operations C product B- relationship B- value B+	77.3	n=6

Arcadia Arcadia.io Arcadia Risk Navigator Plus * L culture B loyalty A- operations C+ product B relationship B value B+	84.5	n=6

Cotiviti Risk Adjustment Solutions * L culture D+ loyalty C- operations D+ product D+ relationship C- value B+	70.4	n=8

Optum Risk Adjustment Solutions * L culture D+ loyalty D operations D product D relationship C+ value C-	65.9	n=6

Vatica Health Risk Adjustment and Quality of Care Solution * L culture A loyalty A operations B product B- relationship A+ value A	89.2	n=6

Veradigm Pulse8 Illumin8 Risk Analytics * L culture C+ loyalty D+ operations C+ product C+ relationship B- value C	72.9	n=7

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