KLAS report evaluates value-based care vendors

KLAS has released a report comparing the performance of eight services firms and software vendors which offer value-based care managed services.

The firms are Evolent Health, Lumeris, Caravan Health, Conifer Health Solutions, Arcadia, Health Catalyst, HealthEC and Lightbeam.

KLAS examined them by four service categories: full service firm; services from a focused firm; services from a population health management software vendor; and a do-it-yourself approach with in-house staff and population health management software tools.

FULL-SERVICE FIRMS

Full-service firms bring technology to the table but lead with managed services, helping large, complex clients with a wide variety of risk arrangements, KLAS said. Clients typically have an urgent need to lead or catch up with value-based care in their local market.

Engagements are expensive and large in scale, involving dozens of firm-supplied resources. These firms are the only ones that both directly invest capital in their client organizations and tie fees to measurable results.

KLAS looked at Evolent Health and Lumeris.

Out of an overall 100-point score, Evolent scored 74.1 and Lumeris 82.2.

Each has a number of clients in this research that are happy with the service they have received, KLAS said. In Lumeris' case, over half are highly satisfied. However, neither firm delivers consistently across clients, with many client frustrations stemming from a lack of execution, the report said.

On a score of highly satisfied to dissatisfied, while 10% of Lumeris customers said they were highly satisfied compared to Evolent's 7%, a greater percentage of Evolent Health's clients expressed satisfaction (16%) compared to Lumeris (5%). On the dissatisfaction rating, Evolent had a score of 8% and Lumeris a score of 3%.

"In general, Evolent overpromises and underdelivers, leading to missed timelines, unkept promises and lack of trust in Evolent's data," KLAS said of the reasons for clients' dissatisfaction rating.

Evolent's provider growth strategy focuses more on physician groups. In the payer market, Evolent focuses on serving existing health plans.

Lumeris was rated as being willing to adapt to unique needs, even if it takes a while.

"At the same time, some report that turnover issues and resource shortages have led to poor execution and a disjointed customer experience," KLAS said.

SERVICES FROM A FOCUSED FIRM

The KLAS report focused on Caravan Health and Conifer Health Solutions, which rated 82.7 and 86.7%, respectively.                                                          

Caravan Health provides less experienced organizations a fast on-ramp to value-based care through Caravan-managed ACOs. The firm's leadership is considered innovative and knowledgeable, KLAS said.

Some clients feel they will eventually outgrow Caravan's standardized approach and are concerned the net benefit will no longer justify the cost.

Conifer Health Solutions' long history of managing capitation for physician organizations and health systems has resulted in accurate, actionable data, a robust tool set, good reporting, and overall reliability, leading to enduring relationships and good perceptions of value, the report said.

Projects for both firms tend to be of low to moderate complexity, be less expensive, and involve fewer firm resources. Typically, clients want to take on a low to moderate level of risk or don't need a full set of services. The two focused firms in this report specialize in different areas and are not in direct competition to each other.

POPULATION HEALTH MANAGEMENT SOFTWARE VENDORS

Population health software vendors rated included Arcadia, Health Catalyst, HealthEC andLightbeam. In respective order, they received overall scores of 90.3, 89.2, 97.4 and 89.3.

PHM software vendors in the value-based care managed services market lead with software but offer limited value-based care managed services, KLAS said. Services are often closely tied to technology, such as support data aggregation and analytics.

With the exception of Arcadia, which has expertise across a broader set of risk arrangements, these firms have experience primarily with shared savings. Clients are typically smaller organizations just starting out which want to avoid deep risk and are content to ramp up over time, forgoing the more comprehensive support of full-service firms in light of tight budgets.

HealthEC is a consistently high performer for their smaller client base, KLAS said. Clients report very strong partnership and collaboration, describing their vendor relationship as unique from any other they have. This includes an appreciation for the firm's executives, whom clients trust.

Acadia is noted for being responsive and transparent when challenges arise and for not shying away from difficult situations and for being willing to adapt to clients' unique needs.

Health Catalyst clients report a strong sense of partnership with the firm's broad bench of experts and say they receive proactive coaching and believe the firm really wants to help them improve.

Lightbeam is a lower complexity firm is highlighted for proactively checking in with clients and soliciting feedback.

DO-IT YOURSELF

Organizations that choose this approach to value-based care are typically large organizations which have the expertise, experience, and infrastructure needed to set up and manage value-based contracts internally, KLAS said. These organizations are often innovative and want to tackle value-based care without the constraints of a third-party partner.

Benefits could include lower upfront cost, greater ability to customize, autonomy in choice of technology partner, and not having to share the money earned from value-based contracts. The trade-offs could be a greater need for upfront capital, longer ramp-up time, an increased risk of losing money, and having to shoulder all of the work internally, including developing resources and expertise.

WHY THIS MATTERS

Reduced regulatory pressure, competitive and financial factors continue to drive organizations toward value-based care, according to the KLAS performance report. Yet making the transition is complex and expensive, especially for smaller or midsize organizations, which may lack the resources and expertise of their larger peers.

It's important for health organizations to define their value-based goals, appetite for risk and the urgency demanded by the local market. Also, what at-risk contracts are available?

Providers must also evaluate their resources and capabilities in-house, including available staff, expertise and budget.

THE LARGER TREND

Value-based care is moving healthcare towards coordinated care intended to improve outcomes and lower cost. It is also pushing providers into financial risk.

The Centers for Medicare and Medicaid Services recently released the numbers for participation in one of the largest value-based care programs, the Medicare Shared Savings Program. CMS is requiring Accountable Care Organizations taking part in MSSP to move into risk, sooner.

For the January 1, 2020 start date, CMS approved 53 applications for new ACOs and 100 applications for renewing ACOs, an increase from 93 ACOs at the start of 2019 to 192 at the start of 2020, according to CMS.

But the National Association of Accountable Care Organizations countered that overall participation in the Medicare Shared Savings Program remains flat CMS enacted risk mandates in December 2018. NAACOs said 517 ACOs are participating in the program in 2020, down from a high of 561 two years ago and 518 last year. Just 35 Shared Savings Program ACOs will enter into their first contract with CMS. Between 2012 and 2018, the program averaged 107 new ACOs annually, NAACOS said.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com