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Payer Quality Analytics 2017
From Regulatory Reporting to Quality Improvement

author - Joe VanDeGraaff
Joe VanDeGraaff
author - Lois Krotz
Lois Krotz
March 16, 2017 | Read Time: 3  minutes

Health plans today look for proactive vendors who go beyond required quality reporting (i.e., HEDIS) to help close care gaps and improve quality. KLAS interviewed 57 payers to see how they view their vendor(s) in this important quest.

Verscend Leads in Performance and Ease of Use; General Dynamics IT’s Impact on Quality Creates (New) Momentum

Verscend Technology’s customers highlight the system's user-friendly analytics capabilities, which in concert with well-guided support help facilitate better performance visibility and communication opportunities with providers. Though General Dynamics IT (GDIT) is seen as historically lacking in innovation and new technology development, a number of clients express appreciation for what they describe as recent efforts by the vendor to improve relationships and facilitate care-gap closure that leads to a healthy impact on quality improvement.

solution usability vs impact on qualityoverall performance fully rated vendors

Inovalon Scores Large Payer Clients—But Doesn’t Score Very Well

A market share leader, Inovalon garners unique interest from large payers, and their client base includes some of the largest health plans in the industry. Notable variability in client experience, however, as well as usability issues and what clients describe as a pushy sales approach, have contributed to a mediocre standing among clients. Another vendor with large market share, Optum is seen as comparable to Inovalon but is used by an unexpectedly minimal number of the payers KLAS interviewed and thus is not shown in the chart to the right. Still, most payers acknowledge Optum as a relevant player. Given Optum’s ownership by United Healthcare, the largest payer, some health plans express concern about Optum’s perceived position as a competitor.

performance vs proactive help guidance

Broader Analytics Vendors: MedInsight Excels; McKesson, HDMS Struggle

While most quality analytics solutions used by payers are HEDIS specific and fully NCQA certified, some payers choose broader analytics platforms for quality analytics. Such use generally represents a limited portion of these platforms’ overall use cases. The MedInsight platform, though described as hard to use and somewhat generic, excels for its depth, configurability, and industry models (from Milliman). Clients using HDMS for performance reporting and quality analytics note recent leadership changes; some view the technology as older and the reports as insufficient. McKesson, once perhaps the market share leader in quality analytics, now has just a handful of quality/HEDIS reporting clients. Clients describe a reactive vendor that gives little prioritization to emerging needs.

overall performance limited data vendors

Vendor Options Plentiful, Yet Few Offer Full Quality Picture

In the course of this research, KLAS learned about or validated use of payer quality analytics solutions from 18 vendors; most, if not all, of these solutions provide some level of quality reporting, analytics capability, and/or HEDIS certification. Few, however, currently tie the full picture into their quality offerings. Go-forward differentiators—such as prebuilt EMR integration, performance-improvement consulting, and member-engagement solutions—are anticipated to become more relevant, even necessary, in a quickly changing market.

payer quality analyticsfingerprint

Cognizant and New Vendors Such as Interpreta Suggest Renewed Market Energy

Regulatory quality reporting is a commoditized space but is still inevitably connected to critical things such as quality improvement and value reimbursement. Seeing this, multiple new vendors have recently entered the market in an attempt to redefine the norm and solve new problems. KLAS has validated some initial customer excitement about Interpreta, signaling potential for real-time quality analytics. While Cognizant (TriZetto) is not as new to the market, early insights show differentiation through what several clients describe as partner-centric planning and a population-focused approach to quality improvement.

author - Elizabeth Pew
Elizabeth Pew
author - Natalie Jamison
Natalie Jamison
author - Robert Ellis
Project Manager
Robert Ellis
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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.