Mergers and Acquisitions 2023
Vendors Learning to Mitigate Negative Impact

Higher-Revenue Vendors at Increased Risk for Post-M&A Performance Decline

Vendors with higher annual revenue are more likely to experience a decline in customer satisfaction following a merger or acquisition. In total, 38% of affected products from vendors with >$1B in annual revenue had a decline in customer satisfaction after their recent merger or acquisition. For companies with annual revenues between $100M and $1B, this number is 13%, and for the smallest vendors in this sample (under $100M), only 11% experienced a decline in customer satisfaction. Customers of higher-revenue vendors often share that new ownership falls short in providing effective communication, leading clients to feel they are no longer as important to the vendor. Higher-revenue vendors tend to have a large number of customers, and smaller healthcare organization clients can feel lost in the shuffle. Vendors can combat this problem by prioritizing effective communication (e.g., proactive outreach, utilizing user groups, increasing the amount of communication) before and after the merger or acquisition. In fact, several higher-revenue vendors have avoided satisfaction declines with strong communication.

Compared to private companies, publicly traded companies have a higher chance of notable change in satisfaction following M&A activity. A much smaller portion of private companies experienced a notable change in customer satisfaction, positive or negative.

Cedar Gate Technologies

Current KLAS performance data

Cedar Gate Technologies acquired Enli and their population health management solution. Client satisfaction remains high after the acquisition. Customers appreciate the vendor’s proactive service and helpful communication. Some have felt a change in the level of executive involvement, but so far this has not affected overall satisfaction to any great extent.

“Cedar Gate Technologies is proactive and wonderful at getting out information when there is downtime or a glitch in the system. The individual that is helping us build the programs is also helping me think through what I want to have as an end result.” —Director

“Cedar Gate Technologies has undergone some organizational changes recently. Before, I felt like their executive team was a lot closer to touch, and now they are a little bit farther away. New customers won’t feel that; I think just me and the customers from before the merge feel that.” —Informatics manager

Conduent

Current KLAS performance data

After Conduent acquired the HSP claims and administrative platform, customers began to report issues like lack of communication and employee turnover. Customer satisfaction overall has declined by more than 7 points (out of 100).

“The system isn’t as good as it was last year. During Conduent’s acquisition of Health Solutions Plus, the vendor was slower to communicate. The acquisition did slow down our progress. Things are starting to pick up now, but there was a gap in progress during the transition period that impacted our business. Requests that normally would have been fulfilled in the same week took two or three months. The company had turnover. We met with the senior management people and raised our issues, and they have taken corrective action as a result.” —IT director

EPSi, now part of Strata

Current KLAS performance data

Strata Decision Technology acquired Allscripts’ EPSi decision support solution. Post-acquisition, customer satisfaction has declined. Healthcare organizations have seen no new product development, and they also share that service and support have decreased.

“The support for EPSi was good until the acquisition, and they went silent for a few months until everything was approved. The vendor lost a lot of their long-term employees, so we are finding a decrease in the service level because there is a smaller number of experienced people and some new ones trying to support us.” —Director

“Before EPSi was acquired by Strata Decision Technology, their development efforts were focused on their cloud platform. They weren’t abandoning EPSi Decision Support, but a lot of their development effort was going into the cloud. When Strata Decision Technology picked up EPSi, they shifted away from any future development of the platform. Strata Decision Technology will continue to support the platform; I don’t see them walking away from it. However, they are not going to put a lot of effort into it. They will take care of anything that is broken, but there won’t be a lot of enhancements.” —Director

Experity

Current KLAS performance data

DocuTAP and Practice Velocity merged to form Experity. Client satisfaction with the Experity DocuTAP urgent care solution has remained steady after the merger. Customers do not note any significant changes to their experience, positive or negative.

“I haven’t seen much of a difference since the recent merger of DocuTAP with Practice Velocity. The only thing that happened after the merger is that our initial contact person went away and a new person came on. That was a good thing. I think that the vendor needs to make sure that they are looking at different workflows. The vendor also needs to check how things are supposed to go for a contract and test those things ahead of time so that we don’t have glitches.” —Director

“Since Experity’s merger with Practice Velocity, we have been asking the vendor what they will do with DocuTAP. There have been no changes, and the vendor hasn’t communicated about any changes. They want to be mindful and slow about changes so they make the right decisions.” —Executive

Flywire

Current KLAS performance data

Flywire acquired Simplee (a digital payments product) to broaden their patient engagement offering. Since the acquisition, customer satisfaction for the product has increased, much of which was driven by higher relationship scores. Clients appreciate Flywire’s attention to their needs and feel like the vendor is a good partner. Several respondents say Flywire’s executives have been very easy to work with.

“I really appreciate the partnership with Flywire. I can’t speak for other people, but in my experience, Flywire seems to have our best interests at heart and tries to work hard to help us. Flywire can be innovative when they need to be.” —Practice manager

“When the vendor was Simplee, we had lunch with the executives regularly. With Flywire, the executives are on regular calls. The change from Simplee to Flywire was bumpy in the beginning, but overall, the changes has been good. Flywire is just so easy to work with. They are the easiest vendor we have.” —VP of revenue cycle

HealthStream

Current KLAS performance data

HealthStream acquired the ANSOS staff scheduling product from Change Healthcare. After the acquisition, HealthStream kept the original ANSOS support staff in place, and this reduced the impact of the acquisition and has helped keep clients satisfied. Although there have been some declines in metrics like nickel-and-diming and money’s worth, metrics measuring loyalty have seen slight improvements, balancing out clients’ overall satisfaction.

“The customer service has been fabulous. I had what I thought was an urgent need on a holiday, and the support people were still willing to work with me through that need. We ended up not needing to do things on that day, but the people were willing to. That says a lot. The tech support is awesome. When HealthStream acquired the product, they took all the ANSOS Staff Scheduling employees with them, and that was good.” —Applications analyst

Hillrom

Current KLAS performance data

Voalte was acquired by Hillrom. Client satisfaction with the clinical communications platform has held steady after the acquisition. Customers report that outreach from account managers and executives helped them through the transition and gave them confidence in continuing the partnership.

“We meet with executives from Voalte a few times a year, and we attend the user conference. We are very engaged, so while the Hillrom acquisition has changed, we still feel connected to some things. I feel like Voalte is committed to staying in a partnership with us.” —Clinical informaticist

“Voalte has a customer relations manager for our account that proactively reaches out, engages us, and works with us. That is something that a lot of vendors could learn from. Also, I have cell numbers from a lot of Voalte’s executives. Voalte’s executives are very responsive and absolutely willing to engage. Now that Voalte has merged with Hill-Rom, it remains to be seen whether Voalte will have the same level of executive involvement or whether their product development will drastically slow down. I have cautious optimism about the merger.” —IT analyst

Lyniate

Current KLAS performance data

Corepoint Health and Rhapsody merged to create Lyniate. They provide integration engines that help organizations interface various systems. Since the merger, customer satisfaction has remained very high, with both KLAS-rated products scoring above 90 out of 100. Customers say communication around the merger was open and transparent and that executives have laid out their road map and effectively resolved client concerns.

“In terms of the merger between Corepoint Health and Rhapsody, I had some concerns at the beginning. But at the user group, the vendor explained things. We asked a lot of questions and got a lot of answers. The conversation was very open and transparent. I still work with the same people that I worked with before, so nothing has really changed. That is a good thing for both sides. The vendor has talked about putting the best of both companies together, and I am anxious to see how that goes. . . . Unless something changes at the very top of the company, I don’t anticipate that the vendor will do anything other than what they have said they will do.” —IT director

“The vendor’s service is very proactive. I would have given them a lower score a year ago. Their support has gotten better, and I don’t know whether that is because they know me now, but my guess is that they inherited some of Corepoint Health’s practices when they merged with Corepoint Health. The vendor’s support right now is really great. After the merger, the vendor’s executives explained why the change happened and listened to our questions. They didn’t need to do that, but they did it. I really appreciate them taking the time to do that.” —IT manager

Nextech

Note: As of 2022, KLAS no longer measures this solution.

Nextech acquired a specialty orthopedics EMR product from SRS Health. Overall customer satisfaction remained fairly steady through the change, though there were some fluctuations in specific areas. Relationship and value scores decreased somewhat, while product and loyalty scores increased.

“Things are really good. There are a lot of changes with government regulations, and SRS Health is working on those changes. The company was recently purchased by someone, but SRS Health still offers very good service. They have a good product. They are trying to work toward more of a true point-and-click EMR. SRS EHR has traditionally been more of a scanning program, but the vendor is always doing what they need to do to stay compliant and to provide a true, certified EHR. The system works really well because it is geared toward orthopedics and ophthalmology.” —IS director

“After Nextech acquired SRS Health, the support line became really hard to get ahold of. A lot of tickets that we put in are being completely missed. The customer service isn’t what it used to be. I have to go through our account manager to get ahold of somebody.” —Manager

NextGen Healthcare

Current KLAS performance data

NextGen Healthcare acquired Medfusion’s patient portal in an effort to boost the patient experience. Several customers say service from the vendor did not suffer following the acquisition, contributing to an initial increase in overall customer satisfaction. After the transition period was over, clients began experiencing other issues that have brought current satisfaction below preacquisition levels, and 58% of clients say the solution is no longer part of their long-term plans.

“One of my favorite things about Medfusion is the customer service they give us. We have been on the system for a very long time. We have had many requests for things we would like the vendor to do. The vendor is on top of things, especially with the scheduling aspect. NextGen Healthcare’s people are friendly. They are very good, and they get back to us right away. I feel like they have become my very good friends; that is how close I have felt.” —IT manager

“I would buy Medfusion Patient Portal again in a heartbeat. NextGen Healthcare knocked support out of the park during the COVID-19 crisis.” —IT director

Palo Alto Networks

Current KLAS performance data

Zingbox was acquired by Palo Alto Networks. Customer satisfaction for the vendor’s IoT security solution declined after the acquisition. Some clients share that they felt blindsided by the announcement, having had no prior warning. Others report that the acquisition affected their partnership with the vendor and say Palo Alto Networks has not been able to figure out how to meet their needs.

“I don’t know how Silicon Valley works, but I know that I am used to a different kind of protocol during acquisitions than Zingbox had. With something like a merger, we would have gotten some kind of notification directly from the company leaving us. Any time we get partners from smaller companies or anybody smaller that is being bought out, we get more of a personal touch. That is what we are used to. It is not that I wanted Zingbox to fly out and sit down with me, but we got an email notification that seemed to come out at the same time as the press. I am guessing that that was to protect the stock. We got the press notification at the same time that we got that email notification, and the interface changed right after that. We could immediately see Palo Alto Networks in the tag, so I know Zingbox knew that this change was coming before they notified customers.” —IT manager

“There are a few products out there that do a pretty similar thing to the product that we have. There are only a handful of products that do IoT well, and I looked at all of them before. Because my relationship with Zingbox is not where it was, as things evolve and my contract expires, I am going to have to determine whether I will keep the system or go to another solution. But if I changed, it would not be because of the product. It would be because of the relationship. IoT Guardian is a pretty new acquisition for Palo Alto. While they bought the company and the product, they haven’t figured out how to make the relationship work.” —CIO

pCare

Current KLAS performance data

pCare acquired a digital rounding solution from TruthPoint. Customers rated the product very high before the acquisition and continue to be very satisfied after the transition. Some note a decline in relationship indicators like executive involvement, but improvements in metrics around value have canceled out any negative impact to overall satisfaction.

“Since the announcement of pCare acquiring TruthPoint, nothing has changed. Given our work history over the last few years, I don’t anticipate any surprises with the change. I feel like TruthPoint has been up front and honest about what we can expect and what they can deliver.” —Director

QGenda

Current KLAS performance data

QGenda has navigated several acquisitions over the last few years. They acquired a nurse/staff scheduling product from OpenTempo and two physician scheduling products, one from Tangier and one from ShiftAdmin. All three products maintained a high level of customer satisfaction after their respective acquisitions. Clients point to a functional product with solid service and support, including involved executives.

“Everything has been great. QGenda’s customer service is the best. The only downfall is that the system does not integrate with the Epic platform yet, but that feature may be on the horizon.” —Manager

“There have been no major issues with QGenda’s acquisition of Shift Admin.” —Scheduling coordinator

“It is just nice to deal with a vendor that cares about their customers. Our main contact always keeps promises and delivers 100%. I can fix most issues that come up, but when I have a glitch or something needs to change, Schedule360 always helps me very quickly and often goes above and beyond what I ask. We have had to make some changes on the fly with COVID-19, and Schedule360 has supported us through everything.” —Director

ShiftWizard, a HealthStream Company

ShiftWizard’s solution for nurse and staff scheduling was acquired by HealthStream. One year post-acquisition, customers rated the product higher on culture-related metrics, saying they had seen HealthStream make a concerted effort to be proactive and keep their promises.

“ShiftWizard has been more proactive in terms of letting us know about different things and issues. Previously if there were issues, we had to be the ones to tell ShiftWizard.” —Project manager

“ShiftWizard has regular meetings with us, and we keep in touch with our account manager and sales representative pretty often. Our sales representative lets us know about things that are coming. That person seems to be proactive about things coming out.” —Manager of finance

Teladoc Health

Current KLAS performance data

Teladoc Health acquired a virtual care platform from InTouch. Following the acquisition, customer satisfaction has remained steady as the platform has continued to perform reliably and meet client needs. Some organizations also highlight proactive communication from account executives.

“The platform is highly reliable, and that is really what has kept us working with the vendor. We plug in the product, and it works. We don’t have to worry about supporting it. If there is a glitch, the vendor is very proactive about detecting it before we know about it. And if there is a problem, the product specialist comes out and fixes whatever the problem is. From a patient perspective, particularly in the hospital setting where we have a majority of the equipment, the patients are receiving a highly reliable service.” —Telehealth manager

“Teladoc Health announced a few months ago that they were merging with Livongo Health. They were extraordinarily open with their customers. Our account executive came around and explained why the merger was a great thing. That person also made it clear that the vendor wasn’t going to change anything. We still have all of our contracts on InTouch Health paper. I thought Teladoc Health handled things really well. By the time the official word came out, the merger was old news to us. We are really hoping that Teladoc Health uses their experience with the direct-to-consumer side to help us with our planned initiatives.” —IT director

UKG (Ultimate Kronos Group)

Current KLAS performance data

Kronos and Ultimate Software merged to create UKG (Ultimate Kronos Group). Four products were measured before and after, and the ERP solution performed best through that change; customer ratings for culture, loyalty, and value metrics improved following the merger. Satisfaction with EZCall and Workforce Scheduler did not change significantly, and satisfaction with Workforce Timekeeper declined slightly.

"Kronos’ support during COVID-19 has been fine. I don’t know that anything additional is needed. Nothing has really changed during the process. Things have gone as expected. We don’t really use normal support from Kronos, but when we do, we have good responses.” —Finance director

“The global support from Kronos is great. I can’t fault them for that. Kronos has good customer service.” —IT manager

Verge Health

RLDatix acquired safety, risk, and compliance vendor Verge Health and has integrated the organization into its operating structure, allowing work with Verge clients to continue as usual. Healthcare organizations’ positive experience with former Verge products has remained steady post-acquisition.

“Verge Health now being a part of RLDatix does not mean a whole lot to us. My contacts at Verge Health have remained the same. The transition has been pretty seamless. We haven’t seen any ill effects, and that is always the desired situation. Other transitions we have experienced have not always been so seamless. I give the vendor kudos because if I hadn’t received an email saying Verge Health was acquired by RLDatix, I don’t know whether I really would have noticed anything different. Our reporting continues to move in a positive direction since it is available pretty much on every device in the organization. The system is utilized all day, every day.” —Manager

VitalWare by Health Catalyst

Current KLAS performance data

VitalWare and their chargemaster management product (VitalCDM) were acquired by Health Catalyst. The product has performed very well in the last few years, and customer satisfaction remains high since the acquisition (overall scores above 90 out of 100). Clients report that the communication surrounding the merger was transparent and that the vendor’s performance hasn’t suffered.

“VitalWare told us an acquisition might happen. They were very transparent about it. They didn’t go into detail, but at least we knew that something was in the works. It doesn’t matter to me who acquires who as long as the vendor’s performance meets my expectations, and VitalWare has never let us down. We like using the software. One of our leaders has used another system in the past but feels that VitalWare is more user friendly for staff members.” —HIM director

Vocera

Current KLAS performance data

Vocera acquired Extension Healthcare’s clinical communications solution. Client satisfaction has declined most notably in terms of relationships. Customers report a sense that communication has worsened under Vocera.

“Vocera offers a good product, but I can’t recommend it to someone else until I see things improve and go back to the way they were before the merger. If Vocera can’t fix their lack of communication problem soon, I don’t know that I will be a customer for much longer. If the issue were fixed and Vocera started communicating the way Extension Healthcare used to, I would be able to tell people wholeheartedly that Extension Engage Mobile was the best product out there. I would feel like I was doing a favor to whoever I told about the product.” —Manager

“Before the merger, I thought the world of Extension Healthcare’s executives; they were involved, and they were meeting our needs. They were great about keeping their promises and delivering on what they promised. Now, things are the complete opposite. I never hear from them. They never make promises anymore, so they can’t break their promises, but the lack of communication is a problem. I never hear from anyone at Vocera anymore. I don’t even know who to contact about sales, and I don’t know whether we have an account representative.” —Analyst

About This Report

Each year, KLAS interviews thousands of healthcare professionals about the IT solutions and services their organizations use. KLAS’ standard quantitative evaluation for healthcare software is composed of 16 numeric ratings questions and 4 yes/no questions, all weighted equally. Combined, the ratings for these questions make up the overall performance score, which is measured on a 100-point scale. The questions are organized into six customer experience pillars—culture, loyalty, operations, product, relationship, and value.

This report specifically focuses on changes in customer satisfaction following mergers or acquisitions by healthcare software vendors. Vendors and their solutions were included in this report if (1) they finalized an acquisition or merger between Q4 2018 and the end of 2021 and (2) KLAS had sufficient data on customer satisfaction (at least 6 unique customer organizations interviewed) one year before and after the change in ownership. Trending data is based on customer ratings one year before the merger or acquisition finalized and one year after.