Risk Adjustment: Coding, Retrieval & Compliance Solutions Software Product Ranking Comparison

Risk Adjustment: Coding, Retrieval & Compliance Solutions

Technology and services that support accurate, efficient, and compliant risk adjustment coding, chart retrieval, RADV compliance/audits, and submissions. These solutions enable healthcare organizations—including health plans, providers, and accountable care entities—to ensure comprehensive documentation of member health status and compliance with risk adjustment regulations and payer requirements.

As payers, provider-sponsored health plans, and provider organizations continue to grapple with economic and financial pressures, their need for risk adjustment solutions with both retrospective and prospective capabilities remains high. Solutions that provide a strong ROI and have broad capabilities are top of mind for potential customers, who often want to realize better value and consolidate solutions. To understand what factors are influencing purchase decisions and where organizations are investing, this report examines 52 risk adjustment purchase decisions validated by KLAS between June 2021 and June 2024. Satisfaction data from current customers is also included.

Report Abstract

Key Findings:

Functionality the Number-One Reason for Selection; Cost a Common Reason for Both Selection & Replacement
Episource’s Purchase Energy Has Grown Consistently; Change Healthcare Customers Leave after Security Breach
Inovalon* & Veradigm Considered but Chosen Less Frequently; Several Inovalon Customers Leave, Citing Unmet Expectations; Veradigm Stands Out for Submissions
Apixio Selected by Multiple Organizations & Current Customers Report Improved Loyalty; Organizations That Replace Edifecs Often Cite Declining Product & Relationship Post-Acquisition
Datavant Chosen for Chart-Retrieval Expertise; Current Customers Note Easy Chart-Retrieval Process
EXL’s Analytics Facilitate Decision-Making for Customers; Arcadia Provides Retrospective & Prospective Analytics, Receives Mixed Feedback on Integration
Vatica Health’s Prospective Solution Identifies Gaps at Point of Care
Matrix Medical Network* & Signify Health*—Vendors Focused on In-Home Health Assessments—Close Quality Care & Risk Gaps despite Shortcomings

*Limited data

Performance Data

Overall Score by Product

Products Appearing in Decisions

Overall Score by Question Topic

Provider Facility Size by Product

Provider Facility Type by Product

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.

Risk Adjustment: Coding, Retrieval & Compliance Solutions

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