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Including payers and payer vendors in our research at KLAS has helped paint a broader picture of healthcare IT and measure healthcare more holistically.

It’s like an SAT question: population health is to the EMR what care management is to the core claims platform. (There’s your SAT throwback for the day.) The problem is that payers often can’t figure

Your health status may be assumed or predicted, at least in part, based on your credit score. So believe researchers at Duke University based on a study published in 2014.

Decision Insights

Payer Care Management 2019

14 August 19 | Doug Tolley, Joe VanDeGraaff and Sam Eaquinto

While utilization management and care management solutions have been around for decades, today health plans are looking for modern technology solutions to help them manage multiple business lines and adapt to changing requirements for value-based care. While innovation overall in payer HIT is not abundant, KLAS has seen an increase in decision energy mostly from relatively or completely new vendors receiving stronger consideration than existing or established vendors. KLAS defines payer care management solutions as systems comprising functionality in areas like utilization management, case management, disease management, and care coordination. 40 unique payer organizations shared insights with KLAS about their purchasing decision process, including which vendors they considered, selected, and decided to replace. As validated in this research, future-state goals (noted below) are becoming increasingly important in these decisions.

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