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Payer IT Consulting 2019
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Payer IT Consulting 2019
Which Firms Can Adapt to Meet the Complex IT Needs of Payer Organizations?

Authored by: Ryan Pretnik and Jennifer Despain May 30, 2019 | Read Time: 3  minutes

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Demand for payer IT consulting services continues to rise as changing market regulations have increased the need for improved efficiency, accurate software, and ways to navigate the complex market environment. This report, KLAS’ first in the market, offers transparency into what payer IT consulting firms offer and their performance, including expertise and adaptability to customer needs (i.e., being flexible in approach and staffing and agile in making changes). At a high level, healthcare-specific firms are delivering more guidance and flexibility than cross-industry firms, though there are exceptions to this trend. 

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Industry Insights | What Payer Services Did KLAS Measure
for This Report?

advisory services technical services

Many payer organizations on older core claims software, the transactional and processing lifeblood of health plans, are looking to move to newer solutions or upgrade to new versions of their current software—just over half of the core claims–related engagements validated in this report are implementation services; about 40% are optimization services. The core claims solutions most often mentioned as being implemented are Cognizant TriZetto, HealthEdge, Health Solutions Plus, and Epic Tapestry.

validated engagements by solution type

performance insights iconPerformance Insights | Which Firms Can Meet Your Needs?

To identify the firm that will best fit your needs, consider (1) the depth and breadth of firms’ service offerings (including their expertise in healthcare) and (2) firms’ performance and delivery (including adaptability to customer needs—i.e., agility and flexibility in approach and staffing).

payer it consulting scope

firm backgrounds

Cross-Industry Firms Typically Less Adaptive—Cognizant Falls Behind Most Due to Poor Delivery

satisfaction vs adaptabilityClients of Cognizant, one of the largest vendors in the payer healthcare IT market, report the firm is difficult to work with, is very expensive, and lacks understanding of the healthcare market and organizations’ unique needs. NTT DATA is seen as having reliable consultants with strong IT skills, but resources may lack strategic expertise, experience in the healthcare industry, and adaptability for more complex organizations. PwC (limited data) delivers mixed experiences; satisfied clients feel the firm is honest and has good bench strength, while dissatisfied clients experience communication issues and feel the firm is not strategic enough.

Deloitte and Accenture (both limited data) perform better than the previously discussed cross-industry firms. Deloitte clients report consultants are highly knowledgeable, are flexible in meeting client needs, and fit into the culture of client organizations. Accenture clients are moderately satisfied overall and report good execution, though some see the firm as less strategic.


Healthcare-Specific Firms FlexTech, Change Healthcare, and Cumberland Provide Most Value

customer experience pillar performanceIn clients’ eyes, FlexTech delivers consistently high satisfaction because of their market knowledge, experienced consultants, and ability to understand the organizations they work with, adjust their approach as needed, and meet organizations’ unique needs. Change Healthcare also has highly satisfied customers; the firm delivers experienced consultants, is flexible, meets clients’ unique needs, and helps keep organizations on track with projects. Both FlexTech and Change Healthcare receive praise for providing good value for their price. Cumberland adapts well to organizations’ needs and brings both payer and provider healthcare knowledge to their projects. HighPoint Solutions (limited data) stands out for offering high-quality consultants for a low cost.

score breakdown

‡ Customer Experience Pillar scores are based on customer ratings that come from the standard KLAS metrics. For details on what metrics are included in each pillar, see page 8.

optum iconOptum and emids Bring Value with Strong Executive Involvement

Optum, who provides services mostly for Optum software and also some third-party solutions, delivers strong strategic expertise through their knowledgeable consultants; clients also mention the firm is responsive (often due to good executive involvement) and provides high-quality service and delivery. The most common complaint from clients is high cost. emids, who mainly does optimization work, also has strong executive involvement, allowing them to accommodate requested changes from clients. They also add value with their technical expertise. Respondents feel the midsize firm is able to keep costs down while still partnering well and bringing in knowledgeable consultants needed for successful projects. A couple of emids clients feel engagements took longer than they expected.

executive involvement vs value
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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.