Risk Adjustment Software Product Ranking Comparison

Payer organizations, provider-sponsored health plans (PSHPs), and provider organizations are expressing growing interest in adopting risk adjustment solutions that provide a wide variety of capabilities and enable consolidation to fewer vendors. Many vendors say they can provide a comprehensive solution, but which actually deliver? Based on the feedback of 163 respondents, this report examines vendor performance across key customer experience metrics and validates customer adoption across the broad spectrum of risk adjustment capabilities.

Recent Insights

Key Findings:

Vendor Snapshots & Customer-Validated Usage
Inovalon and Optum Are Compelling for Their Comprehensive Offerings but Fall Short in Meeting Expectations
EXL’s Strong Analytics Offering Expanding to Broader Capabilities; Advantasure’s Technology Lacking
Apixio’s AI Capabilities and Client Success Program Drive Accuracy, Efficiency; Health Fidelity’s Difficult Implementations Causing Struggles
Pulse8 & Optum Customers Most Likely to Consider Leaving
Pareto’s Analytics and Proactive Partnership Lead to High Satisfaction; Overall MedInsight Experience Improving
Risk Adjustment Pillar Definitions

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

A growing field of vendors offers risk adjustment technology and services. In our latest report, we set out to discover which vendors offer the widest breadth of capabilities.

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.

Analytics and risk adjustment are hot topics due to the expenses associated with value-based care, government regulations, and CMS programs. Pareto Intelligence’s revenue integrity solution attempts to provide organizations with actionable data to improve their risk documentation outcomes. This report examines the Pareto customer experience.

Risk Adjustment

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