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Payer Care Management 2021
Amid Shifts in the Market, Who Will Step Up?

author - Joe VanDeGraaff
Joe VanDeGraaff
author - Jennifer Hickenlooper
Jennifer Hickenlooper
May 27, 2021 | Read Time: 6  minutes

In the past, payers have struggled with vendors’ care management solutions not keeping pace with functionality and support needs. Recent market shifts, such as M&A activity and leadership and ownership changes, along with the need for better payer/provider collaboration have created energy and optimism around the future of some vendors. Which vendors are stepping up, and which are missing the mark? This report focuses on how well vendors are helping organizations achieve desired outcomes through delivery of needed technology, excellent support and service, and follow-through on promises.

ZeOmega Leading with Strong Product; Optimism Growing with HealthEdge Acquisition of Altruista

ZeOmega and HealthEdge customers are optimistic about the future of their products and report current functionality has led to positive outcomes. Customers of high performer ZeOmega report the vendor’s strong integration, configurability, and ease of use have helped them improve automation and gain cost savings. Respondents also share excitement about the upcoming version’s dashboards and mention recently improved reporting has been helpful. Many customers see ZeOmega as expensive, and about one-quarter of interviewed clients report some nickel-and-diming for software configuration, service, and support. Interviewed HealthEdge customers (limited data)—who use either the HealthEdge solution or the recently acquired Altruista Health solution—express high optimism about the anticipated future of the combined companies. In the past, HealthEdge has been perceived as mediocre in care management. However, customers are hopeful about the potential integration of the Altruista care management solution (which has historically generated high market energy) and HealthEdge’s core administration solution.

drives tangible outcomes vs overall product quality

Missed Promises and Delivery Hamper Medecision Clients; Once a Mainstay, EXL Loses Traction 

Medecision, often viewed as a natural consideration based on high market share, struggles to deliver; 6 of 10 interviewed customers are dissatisfied overall. Traditional payers are most dissatisfied. Provider-sponsored health plan (PSHP) customers who are more satisfied often say the vendor worked with them to get the system running. A few respondents report Medecision is starting to listen to feedback through user conferences and an idea exchange. Overall, clients report lack of follow-through on keeping promises and delivering results. They also cite product issues—e.g., poor reporting, too many clicks, workflow problems, and users being booted from the solution during use. PSHP respondents say the tool is less flexible and functional than expected. As a result of these problems, 40% of respondents are actively considering switching to another vendor’s product. EXL customers include some very large payer organizations who have been with the vendor for quite some time. Reviews from clients are mixed when it comes to product functionality, and customers are uncertain of the product’s future—37% of respondents are planning to leave for another solution. Dissatisfied customers say they experience workflow issues, the system is clunky, and it doesn’t function in real time. A few more-satisfied respondents feel the system is easy to use and works well out of the box. EXL has future plans to pivot their offering and act as more of a services provider.

product has needed functionality keeps all promises and part of long term plans

Casenet’s Painful Upgrade Improves Usability; HMS and VirtualHealth Easy to Use 

The customer experience with Casenet over the last year has revolved almost entirely around a required update to the HTML5 version of the product, which has generated positive and negative feedback. Customers report this version includes a new, much more user-friendly interface and dashboard. The implementation process for the update was described as painful for many clients, who experienced issues requiring hotfixes and did not receive sufficient communication from Casenet about those issues. Organizations who had smoother updates mention using a sandbox environment to fix issues before fully going live. Respondents appreciate that Casenet increased available training and support for the update.

HMS, used mainly by small to midsize payer organizations, delivers solid satisfaction and was named Best in KLAS in 2021 (awarded based on client ratings). Interviewed customers report the vendor fosters close relationships, and the system is functional out of the box and can be configured to their needs. Some respondents say it is difficult to get needed reporting and sometimes to initially integrate into physician workflows. A couple of respondents are concerned about how much lift will be required to implement the newest software version because of their organization’s historical heavy customization. Almost all interviewed customers of VirtualHealth (limited data), a newer vendor generating market interest, report positive experiences. Those who are most satisfied say the software works well, is easy to use and create reports with, and works as promised. The one less-satisfied respondent experienced some issues with customer support and functionality. Multiple customers mention that system upgrades sometimes cause problems for organizations that have more heavily customized the solution.

ease of use

Lower-Performing Cognizant Improves Service Experience

Interviewed Cognizant customers (limited data) have seen good improvement from the vendor, especially regarding service and support, though their satisfaction remains low overall (second lowest in this report). Cognizant’s user group has helped give customers a say in what upgrades are most important and urgent. Respondents are also seeing more engagement and a clearer picture of the platform’s direction. Additional improvements from Cognizant include more kept promises, more proactivity around issues, and ensuring escalated problems are resolved. Overall satisfaction is brought down mainly by product issues with workflows, downtime, and APIs/integration. Payers who host the system themselves often report the solution is stable and highly configurable, supporting them in achieving desired outcomes.

Medecision (detailed on the previous page), HealthEdge, and EXL (latter two with limited data) receive below-average ratings for service and support. HealthEdge customers report the vendor’s ability to resolve support tickets in a timely manner is hit or miss. Interviewed EXL customers feel the vendor is more reactive than proactive, both in reaching out about problems and in listening to customers’ technology needs.

quality of phone web support and proactive service

Vendor Overview

vendor overview

About This Report

Each year, KLAS interviews thousands of healthcare professionals about the IT products and services their organizations use. These interviews are conducted using a standard quantitative evaluation, and the scores and commentary collected are shared online in real time so that other healthcare providers, payers, and IT professionals can benefit from their peers’ experiences. The questions from the standard evaluation are organized into six customer experience pillars—culture, loyalty, operations, product, relationship, and value.

customer experience pillars

The data in this report comes from standard evaluations and was collected over the last 12 months; the number of unique responding organizations is given in the chart below.

about this report

What Does “Limited Data” Mean?

Some products are used in only a small number of facilities, some vendors are resistant to providing client lists, and some respondents choose not to answer particular questions. Thus a vendor’s sample size may vary from question to question and may not reach KLAS’ required threshold of 10 unique respondents. When a vendor’s sample size for a particular question is less than 10, the score for that question is marked with an asterisk (*) or otherwise designated as “limited data.” If the sample size is less than 5, no score is shown. Note that when a vendor has a low number of reporting sites, the possibility exists for KLAS scores to change significantly as new surveys are collected.

Overall scores are measured on a 100-point scale and represent the weighted average of several yes/no questions as well as other questions scored on a 9-point scale.

author - Amanda Wind Smith
Amanda Wind Smith
author - Madison Moniz
Madison Moniz
author - Natalie Jamison
Project Manager
Natalie Jamison
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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. © 2024 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.