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Care Management Solutions (Payer)
 

Standalone vendor solutions that provide analytics and workflow capabilities to help healthcare payers manage and improve member/patient health conditions.

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Joe VanDeGraaff
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KLAS SRU Manager - Joe VanDeGraaff
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Payer Care Management 2021: Amid Shifts in the Market, Who Will Step Up?) Report Cover Image
Performance
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Payer Care Management 2021: Amid Shifts in the Market, Who Will Step Up?
27 May 21
In the past, payers have struggled with vendors’ care management solutions not keeping pace with functionality and support needs. Recent market shifts, such as M&A activity and leadership and ownership changes, along with the need for better payer/provider collaboration have created energy and optimism around the future of some vendors. Which vendors are stepping up, and which are missing the mark? This report focuses on how well vendors are helping organizations achieve desired outcomes through delivery of needed technology, excellent support and service, and follow-through on promises.

Recent Insights

Key Findings:

  1. ZeOmega Leading with Strong Product; Optimism Growing with HealthEdge Acquisition of Altruista
  2. Missed Promises and Delivery Hamper Medecision Clients; Once a Mainstay, EXL Loses Traction
  3. Casenet’s Painful Upgrade Improves Usability; HMS and VirtualHealth Easy to Use
  4. Lower-Performing Cognizant Improves Service Experience
  5. Vendor Overview


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Performance Data

Overall Score by Product

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Products Appearing in Decisions

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Overall Score by Question Topic

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Provider Facility Size by Product

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Provider Facility Type by Product

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Related Articles
Article
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KLAS and the Healthcare Payer Market
03 August 21    |   Joe VanDeGraaff
Including payers and payer vendors in our research at KLAS has helped paint a broader picture of healthcare IT and measure healthcare more holistically.
Article
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Coming Together at the Payer/Provider Summit
25 November 19    |   Sharlin Bird
The payer/provider relationship in healthcare is full of speed bumps and roadblocks, a fact unsurprising to even the patients. I was excited (and admittedly a little nervous) to see how both sides wou
Article
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Payer-Provider Convergence
04 October 19    |   Kate Gibson and Marwood Group
On the path to a fee-for-value model, payers and providers must be increasingly moving in lockstep to solve provider outcomes. Whether this means that the payvider method is most effective remains to
Article
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Payer Care Management: Vendors Could Do Better
11 September 19    |   Doug Tolley
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
Current Time Inside Cache Tag Helper: 6/30/2022 8:27:32 PM and Model.SegmentId = 306
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Performance
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Telehealth Ecosystem 2021
20 May 21    |   Adam Cherrington and Ciera Walker
The COVID-19 pandemic greatly accelerated healthcare delivery organizations’ adoption of telehealth and virtual care technologies. As these organizations scrambled to meet the immediate demand, they quickly implemented solutions that often required few resources and met focused needs. At the same time, vendors quickly pivoted to either develop dedicated telehealth products or add telehealth capabilities to existing offerings, creating a sea of options. This study, along with additional deep-dive content on KLAS’ website , shows which vendors report the broadest telehealth capabilities and aims to help organizations navigate different options as they look to consolidate systems and define their long-term telehealth strategy. For reader ease, links to relevant online content are provided where applicable. Note that the vendor-capability data in this report is based on vendor-reported information.
Best in KLAS
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2021 Best in KLAS Awards - Software and Professional Services
02 February 21    |   Mark Allphin and Sam Eaquinto
The Best in KLAS report recognizes software and services companies who excel in helping healthcare professionals improve patient care. All rankings are a direct result of the feedback of thousands of providers over the last year. A Best in KLAS award signifies to the healthcare IT industry the commitment and partnership that the top vendors should provide. Read the report to see the top-rated medical software and services for 2021. Watch sessions from our first-ever virtual Best In KLAS Award Show to hear from the winning vendors in each segment. View Awards Show Recordings
Flash Insights
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Teladoc Health/Livongo Merger
18 December 20    |   Adam Cherrington and Sam Eaquinto
In October 2020, Teladoc Health finalized a deal to acquire Livongo. This merging of two publicly traded virtual care companies creates a telehealth giant amid rising demand for virtual care solutions. In July 2020, Teladoc Health acquired InTouch Health, another telehealth company. This KLAS Flash Insights report will share reactions from customers of all three vendors to the Teladoc Health/Livongo merger and their perception of what impact it will have. KLAS interviewed 30 individual clients—of these, 11 use InTouch Health, 11 use Livongo, and 14 use Teladoc Health (some organizations use two of these vendors’ solutions, but none use all three).
Decision Insights
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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.



Reducing Filters

Unlike sizing filters, reducing filters DO NOT recalculate scores based on the evaluations that meet these requirements. They narrow the list of solutions to show the vendors and solutions that can meet a specific need.

This data is based on interviews with a sample of the firms' recent clients. As a result, it is not necessarily comprehensive of all work a firm may do in this segment.

We require a minimum of 2 confirmations of a service performed in the last 3 years for a solution to qualify.

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