KLAS Ranks Top Healthcare Payer, IT Consulting Services

May 31, 2019 - As healthcare payers work to modernize their healthcare technologies, or even adopt new ones, it will be essential for them to be knowledgeable about the consulting services that may aid those health IT overhauls.

A new KLAS Research report outlines the top health payer consulting firms and the trends that these consulting services reveal.

Consulting services can be segmented into two key groups: advisory services and technical services.

Advisory services pertain to the health IT strategy, planning, and selection process. Healthcare payers may hire a consulting firm for their advisory services when they are looking into a new technology or looking to replace an older one.

Technical services, which are the more common of the two consulting categories, refer to improvements to health IT infrastructure a payer already has in place or is planning to put in place. Instead of guiding payers in the types of tools they should purchase or the types of improvements they should make, technical consultants advise on how the organization will actually reconfigure the tools to improve.

Healthcare payers are primarily working to transition to newer, more sophisticated health tools, especially their claims management software. Over half of the advisory services rendered were targeted toward implemented new claims software, while 40 percent were related to claims software optimization.

Most organizations are implementing Cognizant TriZetto, HealthEdge, Health Solutions Plus, and Epic Tapestry, the KLAS researchers reported.

The report also underscored the growing focus most healthcare payers are placing on population health management. Health plans understand that tending after beneficiaries’ social needs – food, housing, access to care, and other social determinants of health – will ultimately improve the health of the population in the long run. This will ultimately cut payer costs.

As a result, health plans are largely investing in strategy and planning consulting services to understand the best population health management tools on the market.

Payer organizations looking to tap the resources at a healthcare consulting firm must consider numerous factors to ensure they are partnering with the company that best suits the payer’s needs, the report authors stated.

“To identify the firm that will best fit your needs, consider (1) the depth and breadth of firms’ service offerings (including their expertise in healthcare) and (2) firms’ performance and delivery (including adaptability to customer needs—i.e., agility and flexibility in approach and staffing),” the authors explained.

Consulting firms that specifically focus on the healthcare industry may be a better fit than organizations that consult in multiple industry sectors. The top-rated consulting firms according to clients were nearly all healthcare specific, and included the likes of Change Healthcare, FlexTech, Cumberland, Optum, and emids.

NTT Data and Cognizant took up the rear in those rankings, while KLAS did not have enough data to add Deloitte, HighPoint Solutions, Accenture, and PwC to that list.

Firms that are not healthcare specific tended to perform worse because they did not have the specialized knowledge of the healthcare industry that payers needed, the KLAS authors explained.

“Cross-industry firms (especially the larger firms) often struggle with a rigid approach and lack adaptability to payer clients’ needs (i.e., flexibility in approach and staffing and agility in making changes), leading to poor satisfaction,” the KLAS authors wrote. “However, there are exceptions to this trend.”

These firms were not perceived as agile or flexible to client needs, while still being relatively expensive.

“At a high level, healthcare-specific firms tend to have more satisfied clients than cross-industry firms, bringing to bear strategic guidance, high flexibility, and a high quality of service,” the authors said.

Cumberland, FlexTech, emids, and Change Healthcare were each rated as high value because they were flexible to client needs, knowledgeable about technology and healthcare, reliable, and adherent to key deadlines.

“Demand for consulting services continues to rise among payer organizations,” the report concluded. “Market regulations have changed, increasing payer organizations’ need for improved efficiency, more-accurate software tools, and ways to navigate an increasingly complex market. Payers are looking for IT consulting firms who have the expertise to meet their unique needs and a track record of strong delivery.”