2023 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 (2022-2023)	Culture	Loyalty	Operations	Product	Relationship	Value

Vatica Health Risk Adjustment and Quality of Care Solution	92.5	n=13	N/A	A	A+	B+	A-	A+	A

EXL Clarity	88.2	n=13	-5%	A	B	A-	B	A	A-

Apixio HCC Identifier	86.8	n=20	-5%	A-	B	A-	B	A	A-

Pareto Intelligence Risk Solutions	86.7	n=14	-4%	B+	A-	B	B	A-	A

Advantmed ELEVATE Risk Adjustment Insights	85.2	n=6	N/A	B+	A	C	B	B+	A-

Edifecs Talix Risk Adjustment and Analytics Solutions	85.2	n=11	N/A	B-	A-	B+	B	B+	B+

Episource Risk Adjustment and Analytics	84.8	n=27	-3%	B	A-	B	B	B+	B+

Veradigm Illumin8 Risk Analytics	84.7	n=9	N/A	B	B	B+	B	A-	B+

MedInsight Risk Analytics	84.5	n=25	-6%	B+	B+	B	B	B+	B

Arcadia Risk Navigator Plus	79.3	n=8	N/A	C+	B	C	C+	B	B

Datavant (formerly Ciox Health) Ciox Health Risk Adjustment Solution	78	n=21	-5%	B-	B-	C+	C+	B-	C

Change Healthcare Risk View (Risk Analytics)	77.9	n=14	-1%	B-	C+	B	C	B	B-

Edifecs Health Fidelity Lumanent	74.5	n=19	N/A	D	C	B-	C	C+	B

Cotiviti Risk Adjustment Solutions	68.6	n=6	N/A	D	C-	C	D-	C	B-

Inovalon ONE Platform Risk	50.3	n=19	-16%	F	F	F	F	F	F
	50.0	100.0

Company/solution	Trend (2022-2023)	Culture	Loyalty	Operations	Product	Relationship	Value

Vatica Health Risk Adjustment and Quality of Care Solution 92.5 n=13 COMMENTS	N/A	A	A+	B+	A-	A+	A
EXL Clarity 88.2 n=13 COMMENTS	-5%	A	B	A-	B	A	A-
Apixio HCC Identifier 86.8 n=20 COMMENTS	-5%	A-	B	A-	B	A	A-
Pareto Intelligence Risk Solutions 86.7 n=14 COMMENTS	-4%	B+	A-	B	B	A-	A
Advantmed ELEVATE Risk Adjustment Insights 85.2 n=6 COMMENTS	N/A	B+	A	C	B	B+	A-
Edifecs Talix Risk Adjustment and Analytics Solutions 85.2 n=11	N/A	B-	A-	B+	B	B+	B+
Episource Risk Adjustment and Analytics 84.8 n=27 COMMENTS	-3%	B	A-	B	B	B+	B+
Veradigm Illumin8 Risk Analytics 84.7 n=9 COMMENTS	N/A	B	B	B+	B	A-	B+
MedInsight Risk Analytics 84.5 n=25	-6%	B+	B+	B	B	B+	B
Arcadia Risk Navigator Plus 79.3 n=8 COMMENTS	N/A	C+	B	C	C+	B	B
Datavant (formerly Ciox Health) Ciox Health Risk Adjustment Solution 78 n=21 COMMENTS	-5%	B-	B-	C+	C+	B-	C
Change Healthcare Risk View (Risk Analytics) 77.9 n=14 COMMENTS	-1%	B-	C+	B	C	B	B-
Edifecs Health Fidelity Lumanent 74.5 n=19	N/A	D	C	B-	C	C+	B
Cotiviti Risk Adjustment Solutions 68.6 n=6 COMMENTS	N/A	D	C-	C	D-	C	B-
Inovalon ONE Platform Risk 50.3 n=19 COMMENTS	-16%	F	F	F	F	F	F

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

Advantasure Risk Solutions * L	84.1	n=4	C+	A	B	B	A	C

Optum Risk Adjustment Solutions * L	59.7	n=5	D+	F	D-	F	C	D

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

Advantasure Risk Solutions * L culture C+ loyalty A operations B product B relationship A value C	84.1	n=4

Optum Risk Adjustment Solutions * L culture D+ loyalty F operations D- product F relationship C value D	59.7	n=5

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