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The Emerging Payvider Market

The Emerging Payvider Market
Which Vendors Matter Most?

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Provider-owned health plans (payviders) aren’t new, but the payvider market, now permeated with ACOs and new risk-sharing arrangements, is seeing new life and seeking new direction. Which vendors are seen as most critical? Which vendors would clients avoid or replace? KLAS spoke with 44 organizations (health plans), representing more than one-third of the payvider market, to find out.

1. TRIZETTO, DST SYSTEMS SEEN AS MOST CRTICAL IN GROWING PAYVIDER MARKET

Payviders call out 59 different vendors as playing a critical role in their payer-related functions, but only 9 are referred to commonly. At the top of this list is TriZetto (now part of Cognizant), whose notably strong market share via their core claims/administration platforms is contrasted by middle-of-the-road performance. Other core platform vendors referenced multiple times include DST Systems, whose clients use various legacy claims platforms from the vendor but report product stability; Epic, whose Tapestry payer product is often considered rudimentary and completely tied to the Epic EMR; and GE Healthcare, whose presence in the payvider space is mostly associated with their claims administration platform, Centricity Financial Risk Manager. Filling different but still critical roles, McKesson is referenced for their ClaimCheck solution suite, Evolent Health and Valence for population health and managed services functions, and AxisPoint Health (formerly McKesson) for care management and utilization management. Milliman MedInsight stands out in the area of quality/performance analytics.

WHICH VENDORS MATTER MOST?

2. CRITICAL VENDOR ROLES - AS REPORTED BY CLIENTS

3. TRIZETTO STANDS OUT FOR MOST POSITIVE RECENT IMPACT; FIVE OTHERS REFERENCED MULTIPLE TIMES

Payviders most often cite TriZetto as their most impactful vendor, largely due to the irreplaceable role they see that vendor playing in helping keep the lights on. Valence, with a much smaller client base, is highlighted by multiple clients for consistently delivering healthy results with the third-party administrator (TPA) payer services and analytics they provide. DST Systems is praised by clients for their cost structure and their software’s stability. Among other vendors referenced multiple times, Epic is appreciated for their strong impact on care management and care coordination, clients of Evolent Health applaud their vendor’s real-world expertise and TPA services, and Truven Health is commended for their price transparency product.

VENDORS HIGHLIGHTED FOR MOST RECENT POSITIVE IMPACT: LAST 2-3 YEARS

4. AXISPOINT HEALTH (FORMERLY MCKESSON), HEALTHEDGE MOST REFERENCED FOR BUYER'S REMORSE

When asked which vendor they would leave behind and why, respondents reference 32 vendors, with AxisPoint Health (formerly McKesson) and HealthEdge showing up the most. Lagging product development is the primary concern among AxisPoint clients, and frustration with subpar support and product performance is evident among HealthEdge’s care management clients. Buyer’s remorse is not unique to clients of these vendors, however. Dell, DST Systems, and TriZetto are also cited multiple times. Several Dell clients are disappointed with the demise of the Xcelys/Diamond product, some nonhosted DST Systems customers report that they don’t receive enough help for state-specific regulations, and some clients of TriZetto say the product is expensive and has limited care management functionality.

WHICH VENDOR(S) WOULD YOU LIKE TO REPLACE (n=44)

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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. © 2018 KLAS Enterprises, 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.