Payer Quality and Risk Analytics 2018
Different Options for Different Needs

Change Healthcare’s proactive service model and robust quality and risk analytics result in industry-leading overall satisfaction and retention. Frontline users express a desire for more customization, an improved ETL process, and the ability to more frequently ingest and process client data. Clients using MedInsight (a Milliman Company) report tangible outcomes and an enhanced ability to close care gaps. The tool’s complexity drives requests for more training and smoother implementations. Verscend Technologies’ product quality and usability are primary drivers of current client satisfaction; declining performance year over year is a result of high turnover among support and account management personnel and a perceived absence of executive involvement. While some interviewed Inovalon customers appreciate the vendor’s experience and reporting functionality, others lament a lack of innovation and post-implementation support; 59% see Inovalon as part of their long-term plans, down from 70% last year. Optum customers’ high expectations are largely unrealized; issues with chart population, retrieval and risk reporting, and support have all contributed to late CMS submissions and drops in HEDIS ratings.

Payers using MedInsight or Verscend Technologies are significantly more likely than others to regard their solutions as progressive or very progressive. One of MedInsight’s differentiators is the Milliman Advanced Risk Adjusters (MARA) suite of tools, which can be leveraged for predictive analytics from both a concurrent and retrospective standpoint. Though Verscend does not currently support predictive capabilities in their HEDIS/quality offerings, the vendor is recognized as an industry innovator in predictive analytics, and some users speak positively of their ability to forecast a member’s likelihood of hospitalization. While interviewed General Dynamics IT customers express satisfaction with core functionality and nearly 80% include GDIT in their long-term plans, performance scores have declined in every measure. Customers feel they are not being heard or supported due to what they perceive as a lack of investment and innovation—GDIT is considered the least progressive of the vendors fully rated in this metric. Limited data on SCIO Health Analytics indicates innovative, user-friendly risk adjustment functionality, top-tier customer support, and high optimism regarding SCIO Health’s reporting for continuity-of-care gaps.

HEDIS reporting—the traditional focal point of payer quality analytics solutions—is often considered a commodity in today’s healthcare environment, where the focus is increasingly on outcomes. Verscend Technologies’ dependable five-day turnaround consistently meets customer expectations, though feedback is mixed on whether this is fast enough for consistent monthly reporting. Likewise, most of the General Dynamics IT customers KLAS surveyed are pleased with the vendor’s reporting capabilities, responsiveness, and reliability in meeting deadlines. 70% of respondents using Change Healthcare are generally content with the vendor’s responsiveness, standard and custom reports, audits, and quality checks. Over half of interviewed MedInsight users choose not to use MedInsight for regulatory reporting, often because the vendor’s standard reports don’t meet regulatory requirements.