Care Management Solutions (Payer) Software Product Ranking Comparison All

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:

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

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

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

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

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.

Care Management Solutions (Payer)

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