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Risk Adjustment 2021 Risk Adjustment 2021
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Risk Adjustment 2021
Which Vendors Deliver Best?

author - Ryan Pretnik
Ryan Pretnik
author - Jennifer Hickenlooper
Jennifer Hickenlooper
November 2, 2021 | Read Time: 8  minutes

Current Time Inside Cache Tag Helper: 6/10/2023 6:00:48 AM and Model.reportId = 1808

Payer organizations, provider-sponsored health plans (PSHPs), and provider organizations are expressing growing interest in adopting risk adjustment solutions that provide a wide variety of capabilities and enable consolidation to fewer vendors. Many vendors say they can provide a comprehensive solution, but which actually deliver? Based on the feedback of 163 respondents, this report examines vendor performance across key customer experience metrics and validates customer adoption across the broad spectrum of risk adjustment capabilities.

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Current Time Inside Cache Tag Helper: 6/10/2023 6:00:48 AM and Model.reportId = 1808

Key Findings:

  1. Vendor Snapshots & Customer-Validated Usage
  2. Inovalon and Optum Are Compelling for Their Comprehensive Offerings but Fall Short in Meeting Expectations
  3. EXL’s Strong Analytics Offering Expanding to Broader Capabilities; Advantasure’s Technology Lacking
  4. Apixio’s AI Capabilities and Client Success Program Drive Accuracy, Efficiency; Health Fidelity’s Difficult Implementations Causing Struggles
  5. Pulse8 & Optum Customers Most Likely to Consider Leaving
  6. Pareto’s Analytics and Proactive Partnership Lead to High Satisfaction; Overall MedInsight Experience Improving
  7. Risk Adjustment Pillar Definitions
author - Elizabeth Pew
Elizabeth Pew
author - Natalie Jamison
Natalie Jamison
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. © 2023 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.