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Risk Adjustment 2023
Which Vendors Drive Value in a Shifting Market?

author - Ryan Pretnik
Ryan Pretnik
author - Jennifer Hickenlooper
Jennifer Hickenlooper
March 28, 2023 | Read Time: 7  minutes

Strategies employed by payers, provider-sponsored health plans, and provider organizations are starting to become more proactive, and the need for solutions with prospective, predictive capabilities is rising. Additionally, amid rising healthcare costs and economic uncertainty, organizations are looking for solutions that deliver more for less. This report examines risk adjustment vendors’ abilities to drive outcomes and value, their prospective capabilities, and their offerings’ ease of use.

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Key Findings:

  1. Episource & Veradigm Offer Broad Capabilities & Positive Customer Experience
  2. Well-Known Vendors Inovalon, Cotiviti & Optum (Limited Data) Falling Behind
  3. Health Assessments from Vatica Health Offer Unique Approach that Drives Value for Customers
  4. NLP from Apixio Leads to High Accuracy, Narrow Focus Has Some Customers Looking Elsewhere; Health Fidelity & Talix Customers Experiencing Bumps Post-Acquisition
  5. Advantmed Sees Increased Customer Satisfaction after Leadership Changes; Ciox Health Often Used for Chart Retrieval but with Some Missed Expectations
  6. For Analytics, EXL’s Easy-to-Use Offering Aids Customer Utilization; MedInsight & Pareto Intelligence Offer Prospective Capabilities, though Broad Offering Can Add to Complexity
author - Natalie Hopkins
Natalie Hopkins
author - Jessica Bonnett
Jessica Bonnett
author - Andrew Wright
Project Manager
Andrew Wright
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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.

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