Healthcare Payer
Healthcare Payer
Healthcare enterprises have made digital adoption the bedrock of their growth strategies to optimize processes, realize cost efficiencies, and enhance member experiences. They are leveraging digital healthcare services for value-based care and population health management, as well as to comply with changing regulations. To support enterprises on their digital transformation journeys, providers are ramping up their capabilities through vertical-specific partnerships and acquisitions, investments in Centers of Excellence (CoEs), and training, among other things. These efforts are, in turn, driving the need for research and market intelligence on demand and supply trends in healthcare payer digital services.
DOWNLOAD THE FULL Healthcare Payer Digital Services PEAK Matrix® Assessment 2022
This report comprises of three sections:
In this report, we present an assessment of 26 healthcare ITS providers who are mapped on the Everest Group PEAK Matrix®, a composite index of distinct metrics related to a provider’s capability and market impact. We focus on payer digital healthcare services market size and growth, digital service themes for healthcare payers, provider assessments on several capability- and market success-related dimensions, and Everest Group’s independent remarks on the providers to help enterprises make the right sourcing decisions.
LEARN MORE ABOUT Healthcare Payer Digital Services PEAK Matrix® Assessment 2022
The PEAK Matrix® provides an objective, data-driven assessment of service and technology providers based on their overall capability and market impact across different global services markets, classifying them into three categories: Leaders, Major Contenders, and Aspirants.
Anil Vijayan, Partner at Everest Group, will join other industry experts to discuss how several new trends, such as intelligent automation, digitalization, and telehealth have emerged as fundamental driving forces to sustain and transform the healthcare industry.
The speakers will explore:
Thursday, May 19, 2022, at 12:00 pm CDT, 1:00 pm EDT, 5:00 pm GMT, 10:30 pm IST
Live, virtual event
Anil Vijayan
Partner, Everest Group
Sajesh Gopinath
General Manager, UST SmartOps™
Health systems are increasingly seeking competitive proposals post-pandemic to outsource Revenue Cycle Management (RCM) and get the best prices and innovation in contracts. Learn what enterprises want and how providers can win these RFPs.
The hospital revenue cycle process was not immune to the many changes COVID-19 brought to the US healthcare provider ecosystem, causing health systems to significantly shift operations to survive.
Challenges such as financial pressure, regulatory changes, the quality care and patient experience focus, and digital penetration pushed health systems – who traditionally prefer to keep operations in-house – to look outside for support. This drove more than 10% year-over-year growth in sourcing in the RCM market in 2021, and the strong contracting activity continues to gain traction this year.
Several health systems, including MarinHealth, Baptist Health, SSM Health, and Bassett Healthcare, have entered into outsourcing agreements with third-party vendors. However, unlike most past arrangements when sole-source was the dominant sourcing model, RFP-led sourcing is now the preferred model for healthcare providers in the post-pandemic world.
Exhibit 1: Split of new Revenue Cycle Management (RCM) services deals in 2021 – sole-sourced versus RFP-led
Source: Everest Group’s coverage of 32 major RCM services outsourcing providers
Key factors driving health systems towards a competitive route over sole-sourced are:
Healthcare provider enterprises are looking for service providers who can provide end-to-end services covering the entire gamut of Revenue Cycle Management (RCM), rather than discrete, siloed services.
From a decision-making perspective, below are some of the key parameters that enterprises look for when selecting a potential service provider, along with their relative importance rated on a scale of 1 to 10:
Exhibit 2: Level of importance of key buyer decision-making parameters for outsourcing Revenue Cycle Management (2021)
Source: Everest Group’s coverage of major Revenue Cycle Management (RCM) providing enterprises
Service providers need to pay special attention to how they position themselves effectively in the extremely competitive RCM market. The two main levers determining a winning proposal are:
As competitive RFPs rise in the RCM market, providers who can create a differentiated value proposition and align their strategies with the enterprise’s vision will succeed in securing these lucrative deals.
To discuss Revenue Cycle Management (RCM) reach out to us at [email protected], [email protected], or contact us.
Learn more about RCM operations in the healthcare industry in our video, Revenue Cycle Management RCM Operations – Emerging Opportunities & Strategies.
Revenue Cycle Management
VIEW THE FULL REPORT
Healthcare Interoperability
VIEW THE FULL REPORT
Interoperability
VIEW THE FULL REPORT
Interoperability
VIEW THE FULL REPORT
With member experience being critically important to healthcare enterprises, HealthEdge’s acquisition of Wellframe bodes positively for the merged enterprise and consumers. Read on to learn why we like this deal and the synergies between these two health services providers.
HealthEdge’s acquisition of Wellframe announced last month propels the provider of next-gen integrated solutions to health insurers into the high-growth digital member experience market. The deal will bring various benefits to HealthEdge, including Wellframe’s consumer-facing and user-friendly mobile application serving more than 33 million members that delivers personalized content and facilitates seamless connectivity to health plan staff.
In a recent (2020) survey by Everest Group, experience was identified as the most important strategic priority for enterprises. Member engagement has become an important area of investment for healthcare payers. Member experience as a theme is so important that health plans have created a new position, the Chief Experience Officer (CXO), to use their organizational muscle for prioritizing experience.
Healthcare payers realize that great member experience will not only help insurers in smoother acquisition and retention of clients but will also improve their financial performance by reducing the churn rate, improving health outcomes, and saving administrative costs. The industry is also witnessing a shift in the definition of “engagement” from being focused solely on sales and marketing to becoming a holistic approach across the three areas of sales and marketing, services management, and care management.
The acquisition of Wellframe propels HealthEdge into the large and fast-growing digital member engagement market. Coupled with its existing products, this creates a highly differentiated end-to-end solution for customers.
Wellframe’s Digital Health Management platform enables health plans to modernize member-facing services, including care management and advocacy. Wellframe’s Digital Care Management (DCM) solution serves as a digital front door for health plans seeking to engage high-risk members. Wellframe leverages real-time member-generated data and artificial intelligence to identify intervention opportunities across its solution suite.
Wellframe’s data sets of 33 million members combined with HealthEdge’s existing data sets will enable HealthEdge to focus on improving the quality of its insights, helping it not only in care management and member engagement but also in other areas where HealthEdge has traditionally offered services.
The Wellframe acquisition strengthens HealthEdge’s portfolio of SaaS solutions across payer workflow operations. The addition of Wellframe to its portfolio of care management solutions coupled with its existing GuidingCare® solution will enable a full spectrum of services spanning member identification, prioritization, targeting, and member engagement. Additionally, seamless and real-time integration between HealthRules Payor® and Wellframe will generate actionable insights that can lead to real-time member interventions and features that enhance a member’s health plan experience.
The acquisition of Wellframe is a strategic fit for HealthEdge to enter the high-growth member engagement market and compete with incumbents in this space, such as Salesforce and Pegasystems.
We are positive about this deal, particularly for what it means to the market and current market demand. However, it remains to be seen if HealthEdge also makes an entry in the other areas of member engagement, such as sales and marketing and services management, which would deliver even greater value.
Reach out to me at [email protected] with your thoughts on this acquisition or the member engagement market in general.
© 2011-2022 Everest Global, Inc.
