Health IT Vendors To Improve Risk Adjustment Capabilities

A recent KLAS Research report used analytics to evaluate which vendors deliver the best risk adjustment.

According to the report, there is a growing interest in adopting risk adjustment solutions. While many vendors claim they can provide desired solutions, the KLAS report examines which can deliver on that promise. Using the feedback of 163 respondents, the report evaluates vendor performances across key customer experience metrics and validates customer adoption across risk adjustment capabilities.

The report examines vendors based on customer experience pillars. These pillars include culture, loyalty, operations, product, relationship, and value.

“In addition to the questions in the standard evaluation, KLAS also asked respondents to answer two supplemental questions specific to the risk adjustment market,” the report stated.

“The first question gathered scoping information regarding which framework capabilities organizations are currently using from their risk adjustment vendor. The second asked respondents whether they have plans to expand this usage. The data-collection window for these supplemental questions was shorter, resulting in some cases in smaller sample sizes than for the standard evaluation.”

Beginning with evaluating the market share leaders Inovalon and Optum, the report shared that while they are compelling for their comprehensive offerings, the vendors struggle to meet customers’ expectations often due to outdated technology.

According to the report, some vendors are not yet providing comprehensive offerings but are still expanding and starting to gain market traction. EXL has begun developing the organization’s analytics-focused offering to include more capabilities. Early adopters of the capabilities are reporting strong satisfaction.

“Those using EXL particularly for analytics highlight the ease of use and report outcomes such as better data visibility, improved scores, and shared savings. Both groups see EXL as a partner and are optimistic they will achieve additional outcomes as the vendor continues to build out their offering,” authors wrote in the report.

Vendors that incorporate artificial intelligence, natural language processing (NLP), and machine learning are frequently used to improve HCC coding accuracy and close care gaps. However, implementing these capabilities can be challenging, creating poor outcomes. According to satisfaction reports from Apixio’s customers, users are impressed by the vendor’s machine learning and NLP for coding.

“Apixio’s support and partnership — which start at implementation and continue beyond — have helped customers achieve a positive ROI, and customers note that the client success managers help them continue to achieve new outcomes,” the report stated.

Other vendors such as Health Fidelity have strong NLP, with customers reporting improved risk scores and greater visibility into provider engagement. However, according to customers, achieving the desired outcomes with the technology can be difficult due to a lack of training and usability issues.

The report also indicates that developing strong partnerships with customers and vendors leads to higher satisfaction levels. In the case of Pareto Intelligence, consulting services and regular meetings can be included in the tool’s implementation, making customers feel that Pareto is part of their team.

As the desire for risk adjustment solutions continues to grow, vendors will continue to advance their analytic practices to improve patient outcomes.