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Payer Core Administration Platforms 2020

Payer Core Administration Platforms 2020
New Decisions & New Life (A Decision Insights Report)

Authored by: Joe Van De Graaff and Sam Eaquinto May 20, 2020 | Read Time: 18  minutes

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A core administration platform is the transactional heart of a payer organization—it is used to enroll new members, process and pay claims, and manage product lines and benefits. Many of the products in this market, while needed and typically stable, have been around for decades and are highly customized, hosted on-premises, and often seen as old and complex. Many payers are therefore reluctant to replace these systems because the risks and required effort are so high.

But recent buying activity suggests the payer core administration platform market is seeing revitalization. Triggered by the opportunities and challenges of payment reform and value-based care, payers are looking ahead and starting to bid for new vendor partners. 

KLAS spoke with 30 payer organizations who are making or have recently made purchase decisions, and they shared their candid feedback and insights regarding what vendors they have considered, selected, and/or replaced. These interviews reveal new energy and life in a market long overdue for change—in terms of both product and service delivery. 

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Key Findings:

  1. Industry Insights & Context
  2. About This Report
  3. Executive Insights & Research Findings
  4. HealthEdge Clear Leader in Recent New Wins
  5. Market Share Leader Cognizant Nearly Always Considered but Less Frequently Selected
  6. Replacements of SS&C Health (DST) Heat Up; At-Risk Advantasure Starts to Turn the Ship
  7. Despite Performance Decline, Conduent (HSP) Clients Optimistic about Future; Epic Grows among Provider-Owned Health Plans
  8. More Replacements on the Horizon, Including Virence Health
  9. Vendor Profiles
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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.