Care Management 2017
Solutions Struggle to Keep Pace

MARKET OVERVIEW

As reimbursement and care models continue to evolve, health plans pursuing a member-centric approach to care management are looking beyond cost and utilization initiatives for innovation in population health and member engagement. Payer care management products are designed to help health plans understand and manage their members’ care, including current health conditions and prospective healthcare needs and opportunities. As health plans and provider organizations move toward population health and wellness, care management vendors are falling behind.

ABOUT THIS REPORT: KLAS data and reports represent the combined opinions and experiences of actual people from healthcare customer organizations comparing how their vendors, products, and/or services perform when measured against participants’ objectives and expectations. The results of this payer care management report are based on client ratings, experiences, and perspectives. Client ratings on vendor solutions were gathered in the areas of overall performance, innovation, analytics capabilities, impact/outcomes, and member engagement.

1. Casenet, TCS Healthcare Outperform Increasingly Lackluster Market

While performance is currently trending downward marketwide, TCS Healthcare and Casenet continue to perform well above the market average. Vendors are struggling to meet growing expectations of innovation and turnkey functionality, resulting in decreasing payer satisfaction with their ability to achieve outcomes. TCS Healthcare customers, who tend to be smaller, are most satisfied with their solution’s functionality, due largely to highly responsive customer service. Respondents describe the system as easy to learn, customize, and update and TCS Healthcare as easy to work with. While customer satisfaction with Casenet and EXL remains above market average, there is still room for improvement. Casenet clients feel Casenet genuinely understands their needs and appreciate Casenet’s push to leverage as much of the solution’s available functionality as possible, though smaller clients are less satisfied with the vendor’s engagement. EXL respondents note improving support and service availability, “deep” involvement, and a growing sense of partnership that better allows them to get the most out of the solution.

2. Roughly Half of Clients Consider Leaving AxisPoint Health, Cognizant

The care management market is unusual in that the vendors with the largest market share, AxisPoint Health and Cognizant, have a disproportionate number of clients voicing their intention to leave. AxisPoint Health customers, over half of which are planning to leave, point to a recent series of leadership changes, limited field counts, and time-intensive workarounds as reasons for lowered optimism. Health plans using Cognizant—the largest vendor in this report and arguably the most prominent vendor among health plans, given their massive footprint in core claims platforms and other payer HIT—convey their impression that Cognizant can’t meet their needs and doesn’t support their outcomes due to employee turnover, poor communication, minimal development, insufficient integration, and the feeling they are being nickel-and-dimed.

3. Medecision Pushes Pop Health Vision; All Vendors Lack Execution

As care management and population health functionality increasingly overlap, healthcare payer organizations are looking for more potent abilities to stratify risk and close gaps in care. Even customers otherwise satisfied with their care management vendors report slow integration of advanced functionality that could increase reimbursement incentive payments for quality. Medecision, one of the longest-standing and most referenced technology providers in payer care management, leads the decidedly uninspiring market. Respondents suggest their optimism is more reflective of Medecision’s vision than any particular execution. Regarding overall performance, Medecision customers are dissatisfied with the solution’s ROI, describing poor reporting, an antiquated interface, and Medecision’s lack of clinical knowledge; some customers are pleased with the clinical nurses Medecision sends to ensure customers fully leverage the solution. Integration is mentioned as an obstacle by respondents using multiple solutions, and it is a highly visible pain point for multiple EXL users, who feel they would be further along if there were better integration between different EXL applications.

On the Importance of Population Health, from an IT Manager: "As a company, we have taken the member-centric and patient-centric views. . . . We have clinicians, nurses, and dietitians on staff as well as other kinds of staff members so that we can try to drive positive outcomes regarding education, outreach, preventive services, or routine services. A lot of the push toward population health comes from us."

On the Progress of Payer Care Management Solutions toward Population Health, from a CIO:"[The vendor is] just starting to think about population health. It is on their radar, but I do not see a very proactive plan or aggressiveness. To me, this could be a huge differentiator in the marketplace and make a huge difference, but I don’t see them with a stratified vision yet."

4. Among TCS Healthcare and Casenet Clients, Innovation Drives Satisfaction and Outcomes

As utilization, disease, and cost management functionality continues to make way for more member-centric priorities, healthcare payer organizations are increasingly searching for technologies that will enable them to more proactively coordinate provider-level care and manage member wellness. Payer organizations on the whole do not feel their solutions are delivering on pace with their rapidly changing needs. This lack of market innovation contributes in large part to the downward trend in overall market satisfaction. Predictably, those vendors that have come closest to satisfactorily addressing their clients’ desires to more actively engage members and other stakeholders are also those who are perceived to be most innovative: client feedback shows Casenet, TCS Healthcare, and EXL innovating, while others are mired in usability overhauls and bug fixes.

Casenet customers report biannual enhancements, a long-term development road map, and the ability to move from an older version to a new one while skipping the releases in between. Notably, every Casenet customer KLAS surveyed is using Casenet’s latest major release. TCS Healthcare clients appreciate biannual enhancements and bug fixes and say the portal is “very useful” for providers submitting authorization requests. EXL clients describe the vendor as “very open to enhancement discussions,” particularly regarding ever-changing regulations. Customers report Cognizant is behind, focused on fixing frequent defects rather than providing new or innovative features. AxisPoint Health customers describe painful, sometimes bug-ridden upgrades and a wish that the company were more “contemporary.”

Designer
Natalie Jamison

Project Manager
Robert Ellis