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Payer Services

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Boyd Stewart
VP of Payer/Provider Collaboration
KLAS VP of Payer/Provider Collaboration - Boyd Stewart

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Performance
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Healthcare Management Consulting 2025
30 April 25    |   Kevin Huang and Warren Whitford
As the healthcare industry evolves, healthcare organizations often need strategic help to ensure operational success and better serve patients. Management consulting firms, with their wealth of expertise, are uniquely positioned to fulfill this need. KLAS’ Healthcare Management Consulting 2024 report shared which consulting needs were being prioritized by healthcare leaders. Building on last year’s findings, this report shares (1) the scope and type of validated healthcare management consulting (HMC) services provided by firms and (2) how firms perform—first examining the HMC market overall and then the six individual segments it comprises. The report is intended to help healthcare and payer organizations determine which firms may be best suited to meet their complex needs, with a particular focus on level of expertise, actionable deliverables, and outcomes.
Performance
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Payer IT Consulting Services Ecosystem 2023
12 December 23    |   Sam Eaquinto and Trent Davis
Payer organizations are under increasing pressure to maintain regulatory compliance and ensure strong data security at a low cost; thus, they are seeking payer IT consulting firms for help with advisory services, change management, implementations, and managed services. This report—KLAS’ first in this area—defines the broad ecosystem of payer IT consulting services and examines the market through firm-reported capability sets, validations, and performance data. Note: The next report on payer IT consulting services will further dive into customer validations of specific engagement types and outcomes.
White Paper
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How Services Firms Can Drive Successful Client Engagements 2023
04 October 23    |   Sam Eaquinto and Warren Whitford
In 2022, KLAS interviewed 27 HIT services firms with broad market experience, asking them about their best practices for driving successful client engagements. Drawing from those insights and correlating them with the KLAS performance data of high-performing firms, this study—part of KLAS’ Vendor Excellence series—looks at four critical areas firms should evaluate to ensure successful engagements: measurement of outcomes, sales and contracting, internal hiring and training, and engagement execution.
First Look
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CareAllies Value-Based Care Managed Services 2023
06 September 23    |   Bradley Hunter and Jacob Mortensen
Competitive and financial factors continue to drive organizations toward value-based care. A widely varied array of services firms and other vendors offer services and solutions designed to help. This report details CareAllies’ value-based care managed services offering and examines client experiences.
Point of Light
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Points of Light 2023 Case Study 20
15 April 23    |   Aurene Wilford and Boyd Stewart
Inpatient treatment for high-risk cardiovascular patients comes with a significant cost for patients, providers, and payers. Costs are lower and outcomes are better when the care for these patients is effectively managed outside the hospital. To achieve this, the collaborators in this case study combined payer and provider data to better predict costs and patient outcomes and then established a bundled payment contract that reduces the costs of caring for patients with high-risk cardiovascular diseases while ensuring they receive the care appropriate for their condition. Outcomes include reduced hospitalization and lower costs.
Point of Light
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Points of Light 2023 Case Study 21
15 April 23    |   Aurene Wilford and Boyd Stewart
The collaborators in this case study noted that some patient populations were completing preventive annual health assessments at lower levels than other populations. To address this disparity and help clinics close care gaps at the point of care, the collaborators implemented a program aimed at incentivizing frontline staff and physicians on a monthly basis for time spent addressing open care gaps. As a result of the program, the participants have seen improved gap closure, improved performance in quality measures, improved coding accuracy, and higher staff morale and engagement.
Point of Light
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Points of Light 2023 Case Study 17
14 April 23    |   Aurene Wilford and Boyd Stewart
Vulnerable and underserved populations face a variety of barriers that can make it difficult for them to adhere to their prescribed medication regimens, and the impacts of non-adherence—in terms of health outcomes and costs—can be severe. Low medication adherence was a particular problem for the healthcare organization in this case study, whose patient population covers one of the most vulnerable and underserved zip codes in the country. To encourage better adherence among high-risk individuals, this organization collaborated with a payer organization and value-based care partner to identify patients in need of additional support and help resolve their barriers to adherence. Results include better health outcomes and higher CMS Star ratings.
Perception
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Transitions of Care 2022
29 December 22    |   Bradley Hunter and Paul Warburton
Inefficient care transitions lead to wasted time and energy, increased risk of human error, and potentially poor experiences for both patients and providers. Despite the industry’s attempts to ensure the right information is sent to the right people at the right time, healthcare organizations must often revert to manual processes for data entry, verification, and communication. Some organizations use or want to use technology to streamline their transitions of care (TOC). This report—KLAS’ first to look at TOC—draws from the perspectives of 95 healthcare leaders across multiple care settings to understand their adoption of care transition technology, the challenges they encounter in their care settings, and the vendors they are considering.
Perception
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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.


KLAS VP of Payer/Provider Collaboration - Boyd Stewart
Subject Expert
Boyd Stewart
VP of Payer/Provider Collaboration
KLAS VP of Payer/Provider Collaboration - Boyd Stewart




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