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Payer Care Management 2019

Payer Care Management 2019
Decision Insights Report

Authored by: Doug Tolley and Sam Eaquinto August 14, 2019 | Read Time: 10  minutes

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While utilization management and care management solutions have been around for decades, today health plans are looking for modern technology solutions to help them manage multiple business lines and adapt to changing requirements for value-based care. While innovation overall in payer HIT is not abundant, KLAS has seen an increase in decision energy mostly from relatively or completely new vendors receiving stronger consideration than existing or established vendors.

KLAS defines payer care management solutions as systems comprising functionality in areas like utilization management, case management, disease management, and care coordination. 40 unique payer organizations shared insights with KLAS about their purchasing decision process, including which vendors they considered, selected, and decided to replace. As validated in this research, future-state goals (noted below) are becoming increasingly important in these decisions.

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Key Findings:

  1. Focus Areas within Payer Care Management
  2. Lesser-Known AssureCare and VirtualHealth Capture New Attention
  3. Consideration Energy Highest for ZeOmega; Altruista Health & HMS Essette Making Inroads
  4. Household Name Medecision Sees Most Potential Replacements
  5. Post-Purchase Satisfaction: Changes on the Horizon?
  6. Market Segment–Specific Reasons for Considering, Not Considering, & Replacing
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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. © 2021 KLAS Research, 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.