Core Payer Platforms 2016
New Payvider Market Meets Old Technology

1. TRIZETTO AND EPIC LEAD PAYVIDER MARKET IN NEW CORE PLATFORM WINS

Over the last two years, payviders investing in a new core payer platform have most often chosen established vendors TriZetto and Epic. TriZetto, seen as a dedicated vendor for payers, is often given default consideration due to their large market share and multiple solution offerings, of which QNXT has traction with smaller and midsize payers. Those selecting Epic are enticed by the direct integration between Epic’s hospital information system and the core payer platform. DST Systems has also had some new wins, mostly from payvider organizations focused on government programs (i.e., Medicare Advantage).

2. GE HEALTHCARE PROVIDES BETTER CUSTOMER EXPERIENCE—BUT HAS LITTLE MINDSHARE, NO NEW WINS

While mostly recognized as hospital-focused vendors, Epic and GE Healthcare also offer core payer platforms, which are used exclusively by payviders (including MCOs) and are not considered by independent payers. While GE Healthcare delivers a better customer experience and better support than Epic and other core platform vendors in this report, they are rarely considered by payviders looking for a new system and saw no net new wins over the last two years. TriZetto, whose presence extends into the broader payer market, has high mindshare and interest among payviders; clients report a high price tag.

3. DST STRUGGLES MOST IN MARKET WITH NO ESTABLISHED PERFORMANCE LEADER

In terms of vendor performance, the core payer platform market is below most others KLAS measures and currently lacks a true leader. DST Systems customers struggle the most, reporting that the vendor’s poor support, inattentive relationships, and frequent nickel-and-diming outweigh the benefits of the system’s scalability; many customers plan to leave. Epic customers feel their vendor lacks payer expertise, leading to implementation struggles. Despite these challenges, some payviders are optimistic about the future: clients using Epic expect better development, and clients using TriZetto anticipate better focus on relationships.

GE Healthcare (Click to see client comments and experiences)

Epic (Click to see client comments and experiences)

TriZetto (Click to see client comments and experiences)

DST Health Solutions (Click to see client comments and experiences)

4. MOST CUSTOMERS STUCK—CAN NEW ENTRANTS BREAK IN?

Payvider organizations often feel stuck with their core payer platforms—as many as one-third would like to leave their current system but view the costs as too prohibitive and the benefits too small to merit such a change. However, some new activity outside the established vendors is emerging: Aldera, Eldorado, HealthEdge, Health Solutions Plus, and ikaSystems—all better known in the broader payer space—have each seen some emerging activity with payvider organizations, even if that activity has been just one or two new deals.

 This report primarily focuses on customer ratings and feedback for vendors offering software products for core payer platforms. To see KLAS’ research and customer ratings on vendors who offer ongoing, outsourced services for reimbursement and claims processing, please refer to KLAS’ data and reports in our value-based care managed services market segment (see links below). 

Click on the links below for further customer ratings and insights.

VBC Services

2015 Value-Based Care Reimbursement Report

Writer
Elizabeth Pew

Designer
Natalie Jamison

Project Manager
Robert Ellis