KLAS Identifies Top Vendor for Core Administration Platforms

October 27, 2021 - Core administration platforms are essential to a payer’s functions and KLAS has identified one platform that pulls ahead of most of its competitors on most metrics, according to a KLAS report which HealthPayerIntelligence received via email.

Core administration platforms are the technologies that handle enrollment, claims payments, and benefits across different lines of business, according to a previous KLAS report on the subject.

The market has a history of slow evolution. The 2021 KLAS report noted that the market as a whole tends to score very low on KLAS performance measures. Most of the platforms rely on sluggish, legacy systems.

KLAS experts conducted a quantitative evaluation in tandem with a supplemental evaluation that aimed to assess HealthEdge’s place in the market as one of the foremost payer softwares. 

The experts used KLAS decision insights, which draws its data from 26 organizations that have made a verified purchase of a core payer administration software in the past two years. 

Additionally, the report used KLAS performance data. KLAS took 18 months to conduct a standard quantitative evaluation of organizations on HealthEdge. Eleven organizations completed the standard evaluation.

The evaluation used over a dozen ratings and a couple of "yes" or "no" questions. The questions addressed the culture, loyalty, operations, product, relationship, and value of HealthEdge’s core administration platform.

A supplemental evaluation asked customers about how HealthEdge compares to its competitors, the platform’s capacity to function across lines of business, the impact of HealthEdge on the customer’s organization, and what the customer anticipates HealthEdge’s future will look like. Eight organizations completed the supplemental evaluation.

According to the results of these evaluations, HealthEdge surpassed every other core payer administration vendor for the 26 organizations interviewed on both contracts won and contracts considered, with the exception of one unnamed competitor that achieved a higher number of considerations but not as many wins.

HealthEdge features a core payer platform that is native in build, not acquired. The company is expected to soon incorporate its new care management and payment integrity acquisitions into its platform.

Survey respondents emphasized HealthEdge’s flexibility. On a scale of one to nine with nine indicating a high flexibility and configuration rating, eight individual survey respondents rated HealthEdge’s configuration and flexibility as a seven or higher.

While flexibility and strong configuration can make a platform more user-friendly and customizable, it can also be a challenge for organizations when it comes time to upgrade the system.

HealthEdge consumers report higher satisfaction than the market average. While HealthEdge’s competitors average around 64 percent satisfaction, HealthEdge earned an average performance score of 79 percent among organizations that used the platform to manage their core administrative functions.

Consumers were also highly likely to include HealthEdge in their long-term core administrative functions strategies and 93 percent of the respondents stated that they would purchase the tool again.

However, internal changes at HealthEdge and the integration of new acquisitions add a touch of uncertainty to the platform’s future. The company enjoys a lot of confidence from its consumer base, but KLAS experts underscored that only time will tell if the platform can maintain this momentum.

This data may be important to payers going into 2022 as payers are constantly looking to streamline their core processes.

Blue Shield of California sought to streamline its billing processes with consumers by reworking the format of the bill that members receive. 

The new format consolidates the details in an approachable way and offers flexibility in how members can pay the bill. The payer also covers the provider upfront for the member’s services and then works out a payment schedule with members separately.

Early on in 2021, Humana announced that it would be using artificial intelligence to facilitate its member engagement processes. A virtual assistant connected to the IBM Watson Health cloud will be able to offer answers regarding benefits, provider information, and other basic questions.

Health Care Service Corporation (HCSC) targeted a specific problem that self-funded employers face: consolidating vendor-contracted platforms. The payer’s digital tool streamlined a range of typical services, from managing employees’ healthcare spending to health benefits.

These examples—which all occurred in 2021—demonstrate the payer industry’s desire to simplify the healthcare experience for employer partners and members. Streamlining core administration platforms may be another step in that direction as the industry prepares for 2022.