Payer & Payvider Research

KLAS represents the voice of healthcare payers and payviders. KLAS performance data and reports are made possible because many healthcare payers and providers take the time to share with KLAS their experiences and candid feedback about the reality of healthcare technology solutions and services.

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Why do Payers engage with KLAS?

Finding value in our data

Healthcare payers use KLAS data to make better technology decisions. KLAS' ongoing research into healthcare and payer industries provides real user perspectives on the technologies payers and payviders are using to impact their businesses.

What is the benefit for you?

Accessing KLAS

When a payer that engages with KLAS, you receive access to KLAS data that is collected from healthcare providers and payers. This means access to industry reports, user commentary, and real-time ratings. Much like the tens of thousands of healthcare providers who participate with KLAS, payers can access all of these benefits in exchange for being willing to share their experiences with the vendors and services they use.

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Example Payer IT Research Areas

Payer Claims/ Administration Platforms

Care Management Solutions

Pharmacy Benefits Managment (PBM)

Price Transparency Solutions

Vendor Colsulting Services for Payers

Payer Reports

This first-time KLAS report takes an early look at the vendor solutions used for health insurance exchanges and insurance enrollment in the ACA market. Faced with the uncertainty, political instability, and complex regulation that characterize the ACA market today, healthcare payers are searching for vendors who can help them successfully weather the storm. Based on interviews with healthcare payer executives, this KLAS report gives initial but important insight into how well—or poorly—some of the key solution vendors are meeting needs.

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Many health plans today are faced with rapidly changing regulations combined with middle-of-the-road performance from their core claims and administration vendors. Citing poor service and support, old technology, and nickel-and-diming, these health plans are looking for improved innovation and the ability to quickly adapt to industry changes.

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Health plans today look for proactive vendors who go beyond required quality reporting (i.e., HEDIS) to help close care gaps and improve quality. KLAS interviewed 57 payers to see how they view their vendor(s) in this important quest.

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Getting patients engaged in their own healthcare has tremendous potential to benefit patients, providers, and payers in terms of both quality and cost. HIT vendors offer a variety of options to help accomplish the task, but most providers’ engagement efforts are not yet significantly impacting patient health. This report examines the patient engagement landscape and highlights the early successes of those providers and vendors whose strategic approaches to patient engagement are making a difference.

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As the healthcare market shifts from fee-for-service to value-based care (VBC), many provider and payer organizations have been left feeling that they are playing a game with constantly changing rules and which they have little chance of winning. For help handling the immense complexity of transitioning to a new business model, many such organizations turn to value-based care managed services firms. The first chart below shows several key factors organizations will want to consider when choosing a firm, including type and scope of work performed, experience with VBC initiatives, average size of client organizations, lives covered in VBC programs, and overall performance. Also important are how the firms perform in each of the five VBC pillars as well as what clinical and financial outcomes their customers have achieved.

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Healthcare organizations are turning to management consultants for help with the flood of change currently disrupting the US healthcare market. In these high-stakes engagements, healthcare organizations, and therefore the firms they rely on, can’t afford to fail. Luckily, many excellent choices exist among both the more traditional, cross-industry management consulting firms and those that are more healthcare specific. Interviews with 276 provider and payer executives highlight how these firms are meeting customers’ high expectations as well as which firms don’t quite measure up.

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Amid industry changes to reimbursement and care models, health plans are switching their sights from traditional utilization/cost management to member-centric care management and even wellness. Vendor software solutions for care management are plentiful, but are they keeping up with changing client needs? KLAS spoke with 74 health plans to find out.

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The opportunity for customer relationship management (CRM) to have a meaningful impact in healthcare is growing. However, managing relationships with current and prospective patients and physicians often requires new workflows and access to consumer data not typically tracked in healthcare today. Even as this nascent market is still being defined, many vendors claim to help in a myriad of ways. This report will explain which of the most common niches vendors are being used in as well as help providers understand their peers’ current overall satisfaction with vendors’ technology and service.

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New market demands are pushing health systems to take on more risk, resulting in some starting their own health plans. These provider-owned health plans (“payviders”) and other full-risk-bearing organizations like them rely on vendor solutions for core payer functions, yet many of the platforms are decades old. How well do these solutions perform, and will new entrants shake up this reemerging market?

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Healthcare costs are soaring. Insurance premiums keep rising. And for most consumers, healthcare costs are anything but transparent—when the “mystery” bill finally arrives, many are shocked at what they have to pay. This first-time KLAS report takes a very preliminary look at vendor solutions used in the price transparency market and highlights client experiences among payers, employers, and providers.

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It’s been five years since Medicare kicked off an industry-wide transition from fee-for-service reimbursement to a system that rewards quality rather than quantity. Commercial payers are following suit, and providers expect participation is inevitable. Some providers are adopting value-based care (VBC) initiatives in an attempt to remain competitive, while HIT vendors are counting on VBC as a revenue stream. Based on 173 provider interviews, this report examines the progress of VBC and which HIT vendors and solutions are making a difference.

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