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Care Management 2016

Care Management 2016
Changing Market, Changing Needs

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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.




1. CASENET AND TCS STAND OUT FOR PERFORMANCE AND IMPACT; TRIZETTO AND MEDECISION CLIENTS STRUGGLE

Casenet's health plan clients report a highly positive organizational impact, highlighting the vendor’s partnership approach and useful care management product. TCS Healthcare Technologies (TCS) is also seen as being actively involved with and supportive of their clients, who are exclusively smaller health plans, resulting in high performance and an effective impact. TriZetto clients, who are both small and large health plans, have high expectations but see limited progress overall, citing usability issues and very challenging product implementations. While acknowledging the vendor’s important history in care management, Medecision clients struggle to see a meaningful impact due to high expense and difficult (sometimes forced) upgrades.



2. EXL HEALTHCARE CLIENTS LOOK BEYOND PRODUCT-QUALITY HICCUPS TOWARD FUTURE INNOVATION

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.



3. INCONSISTENCY ABOUNDS; CLIENTS OF AXISPOINT AT CRITICAL DECISION POINT

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.



4. HELPFUL ANALYTICS SORELY LACKING; ONLY TCS CURRENTLY SEEN AS SENSIBLE

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.



5. TRIZETTO EMERGES IN (VERY) UNDERDEVELOPED MEMBER ENGAGEMENT AREA

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.

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KEY TOPICS

  1. Casenet and TCS Stand Out for Performance and Impact; Trizetto and Medecision Clients Struggle
  2. EXL Healthcare Clients Look Beyond Product- Quality Hiccups Toward Future Innovation
  3. Inconsistency Abounds; Clients of AxisPoint at Critical Decision Point
  4. Helpful Analytics Sorely Lacking; Only TCS Currently Seen as Sensible
  5. Trizetto Emerges in (Very) Underdeveloped Member Engagement Area
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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2018 KLAS Enterprises, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.