Care Management 2016
Changing Market, Changing Needs

EXL clients, who are often very large health plans, experience what they see as unnecessary hiccups with the product’s code quality. At the same time, however, they see the CareRadius product as a workhorse and applaud EXL’s listening ear and go-forward, customer-focused innovation, including anticipated new partnerships and integrated care management models.

Health plans’ care management experiences vary dramatically. Feedback from AxisPoint Health clients is particularly polarized—some clients (mostly those on the older CCMS product) report plans to leave, fueled by what they see as an underdeveloped and poorly supported solution; others—often those familiar with the vendor’s new leadership and vision—are more satisfied, even expressing optimism about a potential turnaround. Inconsistency is also evident among other vendors’ clients: small payers see breakdowns with TriZetto, while large payers have seen some success; Medecision clients cite optimism for the future but sometimes experience limited progress based in part on varied versions of the product in use.

The need for member-centric and predictive analytics is quickly intensifying, but currently no care management software solutions are seen as setting the bar. Many clients are unfortunately disappointed, including those using the otherwise proactive and high-performing Casenet. Only TCS Healthcare is seen as having reasonably helpful analytics, mostly due to the available preconfigured reports, which are needed but not deemed fully sufficient. Clients using Medecision see some real depth in the vendor’s stratification analytics, though not all take advantage of them; AxisPoint clients expect notable analytics improvements in the future but are just moderately satisfied today.

Health plans highlight the need to engage with their members but rarely view their care management vendor as ready to play a valuable, active role. TriZetto bucks the trend in this emerging area, with multiple clients currently doing member engagement via automated outreach capabilities they built on top of the platform themselves or via newer vendor-provided campaign functionality. While EXL clients do not yet report actively using the vendor for member engagement, several feel the vendor’s future product development will get them there.