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Risk Adjustment & Analytics 2020
A First Look at Vendor Performance

author - Ryan Pretnik
Ryan Pretnik
author - Jennifer Hickenlooper
Jennifer Hickenlooper
September 3, 2020 | Read Time: 8  minutes

In the risk adjustment and analytics space (solutions and services supporting population stratification, reporting, and/or analytics for CMS or other risk-based contracts), four vendors tend to dominate mindshare and market share—Change Healthcare, Cotiviti, Inovalon, and Optum. But market share is not a guarantee of a strong customer experience, and some organizations have started to consider and choose other options. This report shares available vendor options, market perceptions of the most prominent vendors, and an early look at how well vendors meet client needs and drive outcomes. As KLAS research in this market is early, most satisfaction data is limited.

icon1A Note about Vendor Participation: 
Especially in market segments where KLAS research is early, measurement of customer satisfaction relies partly on vendors sharing complete client lists, which KLAS keeps confidential. Advantasure, Health Fidelity, and MedInsight shared full client lists. Apixio, Ciox Health, Optum, and SCIO Health Analytics shared partial lists. Change Healthcare, Cotiviti, and Inovalon declined to participate and are thus measured through market perception data only (see page 5).

Risk Adjustment & Analytics Vendor Landscape

Change Healthcare, Cotiviti, Inovalon, and Optum offer a wide breadth of capabilities, and they are considered in most purchase decisions. In addition, a number of other, often smaller vendors are also options to consider. The following charts, which detail vendor-reported risk capabilities and customer-validated types of work, are a starting place for organizations as they consider which vendor can best meet their needs. Subsequent sections delve into not only what vendors offer but how well they deliver.

risk adjustment and analytics framework
customer reported purpose for using vendor

Apixio, Health Fidelity Provide Strong Support of Risk Adjustment Strategy; Ciox Customers See Some Challenges

vendor support of customers risk adjustment and analytics strategyOf the measured vendors, Apixio is most likely to be seen as going above and beyond in supporting customers’ risk adjustment strategies. Excellent proactive service from Apixio (e.g., helping customers understand processes, answering questions, and brainstorming ideas to improve HCC capture rate and accuracy) leads to partner relationships. Customer outcomes are typically narrower in range—focused on closing HCC coding gaps—but are consistently realized. Health Fidelity respondents are next most likely to report exceeded expectations, in part because of various aspects of the vendor’s technology—for example, a strong risk analytics engine, reporting that shows which patients would benefit most from care management, and NLP capabilities for HCC diagnosis coding and chart review. Ciox Health customers, most of whom use Ciox for chart retrieval, report mixed reviews of strategic support. Most see occasional misses from Ciox, such as failure to retrieve the expected number of charts or trouble working with a payer’s provider clients.

Advantasure Customers Dissatisfied Due to Functionality Struggles and Unkept Promises

Overall and in most areas of customer experience, Apixio and SCIO Health Analytics stand out for strong customer satisfaction. Advantasure receives the lowest satisfaction ratings of measured vendors. While customers use the solution to close risk gaps and get the right information in providers’ hands at the point of care, respondents see the vendor’s technology as less advanced than the other solutions in the market. A few are frustrated about workflows that must still be done on paper, issues with data accuracy, and other areas where functionality could improve, including reporting. Customers feel Advantasure overpromised during the initial sales process. Respondents also report frequent support personnel turnover and a lack of timeliness or follow-through with issue resolution.

customer experience pillars

SCIO Health Analytics, Apixio Consistently Deliver Strong Support, Contributing to Overall High Satisfaction

proactive service and quality of phone web supportSCIO Health Analytics and Apixio (the latter detailed above) both provide consistent, proactive support that enables tangible outcomes and contributes to their customers’ high satisfaction. SCIO Health Analytics customers (often focused on risk adjustment for Medicare) report the vendor is collaborative, proactive, responsive to requests for new technology and functionality, and willing to share best-practice guidance. The vendor’s hands-on approach to initial and ongoing training helps make the system easy to use. Reported outcomes include financial ROI, specifically through shared savings because of more accurate HCC coding. Ciox Health also provides solid support—specifically, interviewed customers praise the vendor’s responsiveness in resolving issues through their support and helpful account managers.

Advantasure, Optum, MedInsight Less Consistent at Helping Drive Outcomes, Often Due to Unmet Expectations

drives tangible outcomes vs keeps all promisesAdvantasure (detailed above), MedInsight, and Optum customers report mixed experiences with vendor-driven outcomes. More-satisfied customers of MedInsight (used solely for risk analytics and population stratification, not risk adjustment for CMS reimbursement) say the vendor has improved communication with provider clients about patient populations, facilitating better care management. Less-satisfied MedInsight respondents have experienced missed expectations due to things like customer support turnover and some data-quality issues. Support, while reactive, could be more proactive regarding problem solving, new upgrades, and training. Most clients of Optum, one of the largest market players, are satisfied with vendor-driven outcomes: for example, improved processes for diagnosis capture during patient interactions, optimized risk scores, and improved risk-based revenue. A smaller number of less-satisfied clients say Optum oversold the product’s benchmarking and data-extraction capabilities. Health Fidelity listens well to customers but has trouble following through on promises about things like product improvements and support. Customers often attribute these misses to the vendor’s growth and some turnover among customer service representatives or account managers.

Market Perception from Non-Customers: Large, Traditional Market Players Perceived as Having Gaps

Almost all payer and provider organizations looking for a risk adjustment and analytics solution at least consider, and often choose, one of the four most prominent vendors in the market: Change Healthcare, Cotiviti, Inovalon, or Optum. The former three declined to share client lists and participate in KLAS research on their customers’ satisfaction, and Optum shared only a partial list. So KLAS asked non-customers to describe their overall perceptions of these vendors. The conversations suggest that the traditional market share leaders have some gaps.

vendors with high market share and mindshare perceptions shared by non customers

Change Healthcare is a very large vendor in the payer space, though less well known for their risk adjustment offering than they are for other solutions. Interviewed organizations have mixed perceptions of Change Healthcare. Some have had positive experiences with the vendor in the past (outside of risk adjustment and analytics). Respondents with a more negative perception mention concerns about responsiveness or are confident their current vendor is a better fit. 

Cotiviti is a core vendor in the quality/HEDIS analytics market, in addition to offering a risk adjustment solution. Compared to the other large vendors, Cotiviti is less familiar to respondents as a risk adjustment and analytics option. Those who have heard of Cotiviti see the vendor as expensive and don’t know much about their software. Many of these use Cotiviti products in other areas outside risk adjustment and analytics. 

Inovalon is one of the largest risk and quality analytics vendors. Respondents report mixed perceptions of Inovalon for risk adjustment. A few feel the vendor oversells on their capabilities. Those with a positive view of the Inovalon solution say it has all the needed capabilities but is expensive. Some see the vendor as difficult to work with. 

Perceptions of Optum tend to be positive. One concern shared by non-customers is that the product seems expensive. For more details on the experience of Optum customers, see above.

About This Report

Data for this report comes from two types of evaluations: standard quantitative evaluations and supplemental evaluations.

Each year, KLAS interviews thousands of healthcare professionals about the IT products and services their organizations use. These interviews are conducted using a standard quantitative evaluation, and the scores and commentary collected are shared online in real time so that other healthcare providers, payers, and IT professionals can benefit from their peers’ experiences. To enable readers to more quickly understand high-level differences in vendor performance and give better context as to how each product compares to other offerings in the market, KLAS has organized the questions from the standard evaluation into six customer experience pillars—culture, loyalty, operations, product, relationship, and value.

customer experience pillars

To supplement the data gathered with this standard evaluation, KLAS also creates various supplemental evaluations that target a subset of KLAS’ overall sampling and delve deeper into the most pressing questions facing healthcare technology today. Organizations who completed the supplemental evaluation for this study were asked to share two types of information: (1) insights on their own vendor’s performance, and (2) their perceptions of other vendors in the market.

The data in this report was collected over the last 12 months. The sample includes mainly payer organizations, but some provider organizations and provider-sponsored health plans were also interviewed. The number of unique responding organizations for each survey type is given in the chart below. Also shown is vendors’ transparency in sharing a full client list with KLAS.

about this report chart

A Note about Vendor Participation & Transparency

Especially in new or newly energetic market segments, KLAS measurement of customer satisfaction relies partly on vendors sharing complete client lists (which KLAS keeps confidential). Given the early status of this research, it is important to recognize the vendors that have taken steps to embrace third-party measurement of their customers’ experience by sharing partial or complete client lists: Advantasure, Apixio, Ciox Healthcare, Health Fidelity, MedInsight, Optum, and SCIO Health Analytics.

With the aim of helping the industry improve, it is likewise important to note the vendors whose transparency and collaboration could be much greater. No performance data is shared for the most prominent vendors in this market—Change Healthcare, Cotiviti, and Inovalon—because these vendors declined to share any client lists or participate in KLAS’ efforts to measure their customers’ satisfaction.

However, because the above non-rated vendors have such large presence and mindshare in the risk adjustment and analytics market, KLAS asked non-customers to share their perceptions of these vendors. It is important to note that this data does not measure customer satisfaction and is instead intended to help readers understand how these vendors are generally perceived.

In the future, KLAS will continue to reach out to customers of Change Healthcare, Cotiviti, Inovalon and other vendors. KLAS encourages participation from all market players in measuring and improving their customers’ experience.

What Does "Limited Data" Mean?

Some products are used in only a small number of facilities, some vendors are resistant to providing client lists, and some respondents choose not to answer particular questions. Thus a vendor’s sample size may vary from question to question and may not reach KLAS’ required threshold of 10 unique respondents. When a vendor’s sample size for a particular question is less than 10, the score for that question is marked with an asterisk (*) or otherwise designated as “limited data.” If the sample size is less than 5, no score is shown. Note that when a vendor has a low number of reporting sites, the possibility exists for KLAS scores to change significantly as new surveys are collected.

Overall scores are measured on a 100-point scale and represent the weighted average of several yes/no questions as well as other questions scored on a 9-point scale.

author - Amanda Wind Smith
Amanda Wind Smith
author - Jess Wallace-Simpson
Jess Wallace-Simpson
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.