KLAS Report Reveals Top-Performing Vendors for Payer Services

Using technology to assist with payer operations can help streamline workflows and relieve administrative burden. The 2024 Best in KLAS Software & Services report highlights the top-performing vendors across payer services, including care management, claims and administration, and quality measurement and reporting.

MHK’s CareProminence and ZeOmega’s Jiva tied for the highest overall performance score for care management solutions, receiving a 79.6 on a 100-point scale.

KLAS also assigns vendors grades for six customer experience pillars. MHK received a C for culture, B for loyalty, C+ for operations, B- for product, B+ for relationship, and B- for value. ZeOmega received a C for culture, B for loyalty, B- for operations, B- for product, B for relationship, and C+ for relationship.

HealthEdge’s Health Rules Payer solution received the highest score for claims and administration platforms of 77.6, just below the market average of 77.7. All of the users noted that the solution is part of their long-term plans.

Edifecs ranked highest in CMS payer interoperability for XEngine Server for FHIR. The score of 92.2 surpassed the 86.3 market average. Customer experience pillar scores ranged from B+ to A+. Payers using this solution reported that the vendor avoids charging for every little thing, it’s part of their long-term plans, and they would buy it again.

For data analytics platforms, Clarify Health Solutions had the top performance score with 89.0, followed by MedInsight with 82.2.

Zelis Healthcare scored the highest in payment accuracy and integrity solutions. The 92.2 performance score complemented an A- in culture, A+ in loyalty, A- in operations, A in product, A in relationship, and A in value.

Lyric received a 90.0, Conduent received an 88.4, and EXL received an 87.0 for their payment accuracy and integrity solutions. Cotiviti’s Quality Intelligence solution (83.8) ranked highest for quality measurement and reporting.

The top spot for risk adjustment solutions was close. Vatica Health’s solution scored 93.6, Apixio received a 91.9, and Pareto Intelligence scored 91.3. Users of all three solutions said the vendors avoid charging for every little thing. Payers using Vatica Health reported that the service is part of their long-term plans and they would buy it again.

Huron was the top performer in IT consulting services (89.5), and Marathon Health ranked highest for employer-sponsored healthcare services (90.4). Proactive MD and QuadMed both scored above the market average for employer-sponsored healthcare services. All of the QuadMed users reported that the vendor exceeded expectations.