Payer IT Consulting Firms: Considering Your Options

KLAS has not seen a slow-down in the conversation or urgency surrounding value-based care, despite some challenges with shifting to VBR. Especially when combined with population health management, the value-based model remains a large piece of the future healthcare landscape.

Payer IT consulting services have an important role to play here as many provider organizations move from a fee-for-service model to value-based care. Payers and providers alike face the challenge of getting a holistic look at patients while effectively and efficiently managing patient populations in specific regions—a huge area for transformation.

A growing number of payviders in the space also face an added complication: integrating the EHR (the lifeblood of providers) and core claims systems (the lifeblood of payers). In view of this complex market environment, it is no surprise that the demand for payer IT consulting services only continues to rise.  

Which firms can adapt to meet these complex needs? In our recent Payer IT Consulting 2019 report, KLAS’s first in the market, KLAS seeks to offer transparency into what payer IT consulting firms offer and how they perform.

Payer Needs

At the outset, many payers contract with Cognizant’s consulting services because of Cognizant’s software offerings. However, the data shows that other well-known payer IT consulting firms may better meet a payer’s needs, especially if the facility is small or midsized.

The Adaptability Factor

Adaptability is one key factor that strongly influences payer satisfaction. Interestingly, the research found that healthcare-specific vendors overall provided better flexibility and guidance for their payers and providers, as compared to the performance of cross-industry vendors. To use a specific example from the report, FlexTech delivers high satisfaction thanks in part to their ability to adjust their approach to meet an organization’s unique needs.   

A few cross-industry firms also perform well. There are also some cross-industry firms that early data shows can adapt better and can help your organization more than some of the others. KLAS recognizes that, for now, this is only emerging data, but it’s something to keep an eye on in the future of payer IT consulting.

The Healthcare-Specific Advantage

Following the trend of adaptability, healthcare-specific firms also provide the most value. This is where being specialized to the healthcare industry seems to offer an advantage. Among several other firms, Change Healthcare has highly satisfied customers because the vendor delivers experienced consultants and offers a good value for the cost.

Present vs. Future

With all the energy surrounding population health, we were somewhat surprised by the type of work that payers—and, by extension, their vendors—focused on. A lot of work is being done in core claims. We thought there would be more work around risk or care coordination and intervention. But it seems that many payers still need to get the core claims piece right.

For now, this focus on core claims seems to speak to the reality faced by payer organizations. However, we are confident that value-based care will become increasingly important in the payer IT consulting market. As people continue to move from fee-for-service to value-based care models, more payers and providers are going to need help.

Other hot areas of future interest for payer consulting include Business Process Outsourcing (BPO) and Business Process as a Service (BPaaS). BPO moves into the different levels of risk for payers, an important piece of value-based care.

Look at Your Options

KLAS employees say repeatedly that there is no one-size-fits-all vendor for every market and healthcare organization out there. This holds especially true with payer IT consulting firms. No single vendor will be the perfect solution for all payer or payvider organizations, so it is well worth the time it may take for an organization to consider their options.

Especially if your organization is small or midsized, there are many firms that are prepared to provide great value and adapt to your specific needs. At the end of the day, you’ll get more attention overall from these firms. To see a full report card and details on the performance of each services firm, check out the report.

Photo Cred: Shutterstock, kan_chana