2019 Healthcare Payer Analytics Market Trends Report
This report is available to subscribers of the Chilmark Advisory Service or may be purchased separately by clicking below. To accompany the release of this report, lead author Brian Murphy will be hosting a webinar presenting and discussing the report’s key findings — register here.
Organizations responsible for paying for healthcare – health insurance carriers, health plans, employers, and governmental organizations – rely on analytics and reporting software to improve performance and better understand their members and clinician networks. This report reviews the current state of the market, categorizes the different kinds of vendors and solutions, and describes in some detail vendors’ capabilities for meeting the needs of their payer customers. It complements the Provider Analytics MTR that was released in early 2019 and will focus on the solutions that are enabling greater payer efficiency, cost and quality measurement, contract management, and network optimization.
Historically, payer analytics vendors used claims data almost exclusively. This data source, although time lagged, supports a robust set of applications that meet many performance improvement needs for different kinds of payers. More recently, payers have begun adopting analytics technology to support the transition from fee-for-service (FFS) to value-based care (VBC). The variety of pay-for-performance (P4P), pay-for reporting (P4R), and risk- and revenue-sharing programs with providers has caused payer organizations to invest in applications that help balance cost and quality through a better understanding of their members’ healthcare needs and risks. These applications need combined provider and payer data to deliver insights to users, and allow payers and providers to share a common understanding of cost, quality, and utilization performance described in value-based care contracts.
For now, cost, quality, and utilization reporting remain the common thread among organizations using analytics tools, looking to achieve immediate goals like improving HEDIS measures and HCC scores, finding fraud, waste and abuse, and controlling total cost of care and identifying cost drivers. Payers are also turning to advanced analytics to predict a range of outcomes, costs and events.
However, capitalizing on the value these tools provide remains a challenge. Payers find that current analytics tools are excellent at identifying areas for improvement but need engaged clinicians and members to take appropriate action. The offerings also need to do more to offer non-analysts the actionable insights they need to make measurable changes on their own.
This comprehensive report provides an overview of the payer analytics and reporting market and evaluates offerings from 18 leading vendors, classified under three categories based on data focus: claims analytics, clinical analytics, and technology-enabled services vendors. Each profile includes an assessment of the vendor’s strengths and challenges, plus detailed descriptions and evaluations of both the product capabilities and market execution across 21 categories.
Vendors Profiled: Arcadia, CareEvolution, Cerner Corporation, Change Healthcare, Clarify Health Solutions, Forward Health Group, Health Catalyst, HealthEC, IBM Watson Health, Lightbeam, MedeAnalytics, Medecision, Milliman, Optum, Philips, SCIO-EXL, SPH Analytics, ZeOmega.
Matt Guldin · 3 years ago
Naveen Rao · 5 years ago
John Moore · 2 months ago
Chilmark Team · 2 months ago
Jody Ranck · 2 months ago
Primary Care for the 21st Century: Technology-Enabled and On Demand
This report is available to subscribers of the Chilmark Advisory Service or may be purchased separately by clicking below. To accompany the release of this report, lead author Alex Lennox-Miller hosted a webinar presenting and discussing the report’s key findings — watch now.
Primary care is the most common touchpoint in medicine, and yet increasing patient demand, expanding provider responsibilities and evolving payment models threaten the sustainability of this essential element of the healthcare system. New technological approaches combined with the drive to move care to lower cost settings are enabling new care models that better meet patient needs and still allow providers to maintain a longitudinal relationship and central role in defining patient care.
This latest report from Chilmark Research, Primary Care for the 21st Century: Technology-Enabled and On Demand, examines three new types of solutions that contribute to or complement the modern technology-enabled primary care practice:
These new methods of delivering technology-enabled primary care offer novel ways for patients to access care directly, for providers to gain greater visibility into the patient’s life and experience, and for both sides of the care loop to communicate. If primary care barriers to access, burden, and costs are not addressed, patients will continue to move towards solutions that offer convenience but do not help with long-term care and needs, such as retail and urgent health clinics. These technology solutions offer ways to not just improve care, but to support value-based payment models that will soon be the norm.
Each type of solution (Telehealth; Virtual & Remote Care Platforms; and AI-Enabled Assistants, Symptom Checkers and Chatbots) is evaluated based how it affects barriers to access, burden, and costs for both providers and patients. The report provides important information about use cases, subcategories of product offerings, reimbursement options, and other obstacles to adoption for each type of solution.
In addition to the categorical analyses, the report includes 11 short profiles of major and promising vendors, with three to four vendors identified per solution type. Each profile includes product differentiators and vendor-specific impact on access, burden, and costs.
Precision Medicine and Health IT: New Data, New Challenges
This report is available to subscribers of the Chilmark Advisory Service or may be purchased separately by clicking below. To accompany the release of this report, lead author Jody Ranck hosted a webinar presenting and discussing the report’s key findings — watch now.
Precision medicine (PM) is slowly entering the mainstream of health and medical discourse but is still a term in need of concise definition to move beyond the origins in genomics to the present, where PM must also encompass population health management.
The most effective manner to build a bridge between past and present is to define PM as an “effort to collect, integrate, and analyze multiple sources of genetic and non-genetic data and applying data analytics and machine learning/AI to develop insights about health and disease that are tailored to an individual.”
-Kadijah Ferryman and Mikaela Pitcan in What is Precision Medicine?
This report discusses the broader definition of precision medicine, including the topics of pharmacogenomics, genotyping / sequencing, microbiomics, and radiomics & digital pathology. After introducing the various -omics data now being collected for PM purposes, the report looks at how EHRs and other health IT platforms are currently integrating this information (or not) and what major hurdles continue to limit the possibility of more broad implementation of precision medicine strategies.
The report goes on to discuss the role of new initiatives and technology that are intended to accelerate, or at least support, the continued adoption of precision medicine techniques in the provision of care. It closes with a series of seven vendor profiles and a brief list of other vendors to watch in the space.
Report Length: 31 pages
2019 Healthcare Provider Analytics Market Trends Report
This report is available to subscribers of the Chilmark Advisory Service or may be purchased separately by clicking below. To accompany the release of this report, lead author Brian Murphy hosted a webinar in which he shared some of the key findings of this report and answered questions about the trends in analytics that are driving modern changes to healthcare delivery.
UPDATE (11/13/2019): The companion report on payer analytics is available now!
Our extensive research for this report uncovered a market wherein today’s leading analytics applications are beginning to address broader needs than just VBC. This is causing greater separation in the relative capabilities of vendor solutions in the market today, with some vendors still primarily focused on VBC and care management needs, while others move to address EPM.
This comprehensive report provides an overview of the market for provider enterprise analytics and evaluates offerings from 23 vendors. It finds that vendor offerings mirror EHR penetration. Providers in acute and ambulatory settings have many choices for analytics across multiple use cases. Providers in post-acute settings and others with low-EHR penetration have relatively fewer choices.
This report characterizes current analytic solutions as either “mainstream” or “advanced.” Most HCOs have experience with mainstream analytics – applications that characterize and summarize current performance. While the underlying technology and general approach is well-established, mainstream analytics has yet to supply a robust predictive insight and prescriptive guidance; for that, HCOs are looking at advanced analytics.
Advanced analytics consists of interrelated technologies, the most common of which are artificial intelligence/machine learning, natural language processing (NLP) and extraction, and big data technologies. These technologies and techniques, while not widely deployed in healthcare, are all used to varying degrees by most of the vendors profiled in this report. The expectation is that as these technologies mature, advanced analytics will offer more accurate predictive and prescriptive capabilities.
Vendors were compared on a specific set of consistent product capabilities and market execution metrics. To provide a detailed basis for comparing the offerings of different vendors, we broke down analytics functionality into the following categories:
We defined the following categories as appropriate metrics to compare vendors on market execution:
Vendors Profiled: Allscripts, Arcadia.io, athenahealth, CareEvolution, Cerner, Change Healthcare, eClinicalWorks, Epic, Forward Health Group, Health Catalyst, HealthEC, IBM Watson Health, Innovaccer, Lightbeam, MedeAnalytics, Medecision, MEDITECH, NextGen, Optum, Philips, SCIO Health Analytics, SpectraMedix, and SPH Analytics.
Report Length: 72 pages
To learn more about this report, please contact John Moore with any questions.
Bundled Payments: Current Strategies and Tools
This report is available to subscribers of the Chilmark Advisory Service or may be purchased separately by clicking below. To accompany the release of this report, lead author Matt Guldin hosted a webinar on managing bundled services in healthcare.
Recent CMS rule changes have once again brought bundled payments into the national spotlight. Addressing established uncertainty amongst payers and providers on the future of bundled payments, Chilmark’s latest report analyzes the market trends shaping this space and describes available IT solutions to help healthcare organizations (HCOs) adapt to these new value-based payment programs.
These models vary depending on payer, providers and type of service. Regardless, managing the efficient delivery and cost as well as understanding performance in a timely fashion will be key to success. This report examines the vendors that are either taking on risk in partnership with providers or are providing analytic solutions that enable the administration of bundled payments by payers and providers.
The report starts by shedding light on the challenges that have plagued efforts to implement these payment models. This includes questions about how smaller-scale HCOs will adapt to increased collaboration requirements, to what extent actual cost savings can be realized through bundling, and concerns about the efficacy of existing IT solutions for enabling the payment models
In addition to providing context into how bundled payments might serve as a market disrupter, the report examines how existing health IT solutions can also limit this disruption. Since no vendor currently supplies a comprehensive solution for handling the intricate requirements of bundled payment programs, providers are forced to assemble a solution from various components of other tools. The report also looks to the future and identifies likely candidates for supplying a comprehensive solution once the market demands one.
Eighteen vendors were profiled for this report, divided into five categories: Acute EHR, Care Management, Consultants, Medical Devices, and Niche Episodic Payments. Each of these vendors is ranked according to their functionality in providing the following services: Opportunity Analysis, Episode Definition, Quality Reporting, Cost Reporting, Contract Management and Reconciliation, Patient Engagement, Care Navigation Workflow, and Clinical Pathway Support. By looking at these components, the report assesses the market’s progress toward developing a general-purpose bundled payments offering for provider organizations.
Vendors profiled: Archway Health, Aver Inc., CareEvolution, Carrum, Cerner Corporation, Change Healthcare, Clarify Health, DePuy Synthes Advantage, Epic Systems Corporation, Medecision, Medtronic Orthopedic Solutions, naviHealth Inc, Optum, Premier Inc, Remedy Partners, Stryker Performance Solutions, xG Health Solutions, Zimmer Biomet Signature Solutions
Telehealth 2018: Vendor Assessment and Market Outlook
This report is available to subscribers of the Chilmark Advisory Service or may be purchased separately by clicking below. Chilmark’s Managing Director, John Moore, hosted a webinar to accompany the release of this report. He was joined by Ann Mond Johnson, CEO of the ATA, and Dr. Brian Zack, Medical Director of Telehealth at University Hospitals Cleveland. Click here to view the webinar and access slides.
With dynamic shifts in the business of healthcare delivery and reimbursement, the market for telehealth solutions is poised to expand from its historical role supporting clinical care within hospitals to supporting patient care and self-management beyond the clinic walls, according to the latest report from Chilmark Research.
Along with consumer demand for more convenient care options and increasingly favorable insurance reimbursement policies, the growth of value-based care (VBC) business models has triggered greater interest in solutions that help healthcare organizations (HCOs) keep track of patients after care encounters. With penalties rising for HCOs that fail to prevent readmissions or improve clinical outcomes, it’s more important than ever to empower patients with technology solutions that help them self-manage their health and wellness.
In addition to examining what traditional healthcare stakeholders must do to support telehealth beyond the hospital, this report considers the role of emerging stakeholders – a list that includes retail health, urgent care, employer-sponsored clinics, digital therapeutics solutions, and the “smart home” enabled by voice-activated virtual assistants. Together, these emerging stakeholders demonstrate how patients’ first point of interaction with healthcare services is quickly being disrupted by consumer-centric business models and technology solutions.
The report includes profiles of 12 vendors identified as representative market leaders due to factors such as brand awareness, market visibility, support for patient self-management, proven outcomes, ease of use, and product vision. These vendors are divided among three core competencies of telehealth technology: Direct-to-consumer (DTC) solutions, acute care solutions, and remote patient monitoring (RPM) solutions. For each profiled vendor, the report provides a heat map identifying which sites of care and underlying telehealth technology solutions are high, medium, or low priorities or roadmap items.
A webinar accompanying the release of the report is scheduled for early December. You can also read some of the report’s findings on provider adoption of telehealth technology on our blog.
Recent Market Scan Report Bundle: App Stores, NLP, and PRM
We are currently offering a bundled discount on our three most recent Market Scan Reports:
Each report retails individually for $2,750, but we are offering all three for $6,000 – that’s $2,250 off the full price!
To learn more about each report, please click on the links above. To take advantage of this offer, please click the button below.
Healthcare App Stores: Status and Outlook Market Scan Report
Digital healthcare, fueled by the industry’s diverse information sources, is a massive opportunity for patients, clinicians, and organizations. As modern APIs gain acceptance in healthcare and emerging app stores promise to transform how health data is accessed and used, Chilmark Research is proud to present our latest Market Scan Report, Healthcare App Stores: Status and Outlook.
This report surveys the current state of app stores in healthcare and describes some of the reasons that the number of developers, the number of companies involved, and the number and variety of available apps will increase over time. It also includes an analysis of opportunities and challenges for adoption and an overview of the different types of app store platforms.
Currently, electronic health records (EHR) vendors sponsor the best-known healthcare app stores on the strength of the volume, variety, and value of data their products collect. As such, the report also includes 7 profiles of leading EHR vendor-hosted app store platforms.
Healthcare stakeholders will need to think differently about how applications further clinical, financial, and administrative goals in order to capitalize on the app store opportunity. Whether the goal is revenue growth, operational cost reduction, regulatory adherence, better patient or member experience and retention, higher quality, lower medical and pharmaceutical costs, app stores will soon catalyze more innovation.
Developers interested in creating apps for these platforms and organizations considering launching their own platforms or apps will benefit from the report’s explanation and evaluation of the different app store platforms. Additionally, leaders of provider and payer organizations will also appreciate the report’s analysis of the technology and market context as they consider encouraging widespread app use and access to their data for patients and workers. Finally, regulators and patient privacy advocates will find this report valuable for understanding who controls these new methods for accessing and using patient data.
Vendors Profiled: Allscripts (Developer Program, ADP), athenahealth (More Disruption Please), Cerner (CODE), eClinicalWorks (Open Interoperability), Epic (App Orchard), MEDITECH (Greenfield), NextGen Healthcare
Number of Pages: 22