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2024 BEST IN KLAS
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Risk Adjustment 2024
Need for Both Retrospective & Prospective Capabilities Remains High
Author
Bradley Hunter
Author
Jennifer Hickenlooper
As payers, provider-sponsored health plans, and provider organizations continue to grapple with economic and financial pressures, their need for risk adjustment solutions with both retrospective and prospective capabilities remains high. Solutions that provide a strong ROI and have broad capabilities are top of mind for potential customers, who often want to realize better value and consolidate solutions. To understand what factors are influencing purchase decisions and where organizations are investing, this report examines 52 risk adjustment purchase decisions validated by KLAS between June 2021 and June 2024. Satisfaction data from current customers is also included.
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Key Findings:
- Functionality the Number-One Reason for Selection; Cost a Common Reason for Both Selection & Replacement
- Episource’s Purchase Energy Has Grown Consistently; Change Healthcare Customers Leave after Security Breach
- Inovalon* & Veradigm Considered but Chosen Less Frequently; Several Inovalon Customers Leave, Citing Unmet Expectations; Veradigm Stands Out for Submissions
- Apixio Selected by Multiple Organizations & Current Customers Report Improved Loyalty; Organizations That Replace Edifecs Often Cite Declining Product & Relationship Post-Acquisition
- Datavant Chosen for Chart-Retrieval Expertise; Current Customers Note Easy Chart-Retrieval Process
- EXL’s Analytics Facilitate Decision-Making for Customers; Arcadia Provides Retrospective & Prospective Analytics, Receives Mixed Feedback on Integration
- Vatica Health’s Prospective Solution Identifies Gaps at Point of Care
- Matrix Medical Network* & Signify Health*—Vendors Focused on In-Home Health Assessments—Close Quality Care & Risk Gaps despite Shortcomings
*Limited data
Writer
Sarah Brown
Designer
Breanne Hunter
Project Manager
Andrew Wright
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.