Cloud data platforms have traditionally been used to facilitate an organization’s data migration on to the cloud to manage it efficiently and securely. Today, enterprises are increasingly adopting these platforms to not only manage data efficiently, but also leverage their analytical and business intelligence capabilities to enhance decision-making. In healthcare, the complexities of managing data continue to be a concern as enterprises struggle to deal with growing data volumes and complexity, as well as siloed and legacy data systems. Additionally, rising digital adoption, the proliferation of remote health devices, and the adoption of new care delivery models (telehealth and virtual care) are pushing healthcare enterprises to rely on modernized cloud data platform models to better manage data and generate actionable insights. In this report, we assess 15 cloud data platform vendors featured on the Cloud for Healthcare – Data Platforms PEAK Matrix® Assessment 2022. The platform vendors are mapped on the Everest Group PEAK Matrix®, a composite index of a range of distinct metrics related to a vendor’s capability and market impact. The assessment will enable buyers to choose a platform vendor based on their sourcing considerations, while platform vendors will be able to benchmark their performance against their competitors. Scope Industry: healthcare Offering: cloud data platforms Geography: US Contents This report offers: An assessment of 15 cloud data platform vendors on capability and market success dimensions A detailed profile of each vendor, including a capability overview, case studies, offerings, recent developments, and enterprise sourcing considerations Membership(s)Healthcare Payer and Provider Information Technology Sourcing and Vendor Management

Cloud data platforms have traditionally been used to facilitate the migration of an organization’s data on to the cloud to manage it efficiently and securely. Today, enterprises are increasingly adopting these platforms to not only manage data efficiently, but also leverage their analytical and business intelligence capabilities to enhance decision-making. In healthcare, the complexities of managing data continue to be a concern as enterprises struggle to deal with growing data volumes and complexity, as well as siloed and legacy data systems. Additionally, rising digital adoption, the proliferation of remote health devices, and the adoption of new care delivery models (telehealth and virtual care) have further pushed healthcare enterprises to rely on modernized cloud data platform models to better manage data and generate actionable insights. In this research, we present an assessment of 15 cloud data platform providers (that serve the healthcare industry) featured on the Cloud for Healthcare – Data Platforms PEAK Matrix® Assessment 2022. The providers are mapped on the Everest Group PEAK Matrix®, a composite index of a range of distinct metrics related to a provider’s capability and market impact. Scope Industry: healthcare Offering: cloud data platforms Geography: US Contents This report comprises three sections: Market trends for healthcare cloud data platforms An assessment of 15 cloud data platform providers on capability- and market success-related dimensions Enterprise sourcing considerations, highlighting the strengths and limitations of each cloud data platform provider Membership(s)Healthcare Payer and Provider Information Technology Sourcing and Vendor Management

On an average, a payer spends 85-90% of its revenue on claims payments, and, hence, an efficient claims management process is vital for cost optimization. However, current workflows are characterized by a heavy dependence on manual processes and siloed operations, resulting in pricing and billing errors, incorrect claims denials, and high claims processing times. In this Everest Group research, we showcase the current state of payers’ claims management processes and the associated inefficiencies. To overcome these efficiencies, payers need to adopt a digitalization approach that allows them to build a digital layer over their existing claims management systems, rather than embracing a rip-and-replace approach, which is marred by limitations such as high costs, downtime, and data loss. Such a digital claims management model, characterized by Artificial Intelligence (AI) / Machine Learning (ML) tools and strong IT and business collaboration, will enable payers to accelerate the claims settlement cycle, improve accuracy, and drive cost savings. Scope Industry: Healthcare payer Geography: US Contents In this viewpoint, we study: Inefficiencies in the existing claims management workflow Scaled digital adoption in the claims management workflow Enablement of business and IT collaboration The business case for change Membership (s) Healthcare Payer and Provider Information Technology Sourcing and Vendor Management

COVID-19 has fundamentally altered the functioning of the healthcare industry by significantly changing who receives care and how they access it. The pandemic has also posed several challenges for payers, such as disruption of member service operations, administrative inefficiencies around provider network management/coordination, member communication, and claims management. Now that the dust is settling and organizations are again turning profitable, they are looking beyond the immediate issues of cost takeout, care delivery, and capacity utilization toward building resilient business models, improving care outcomes, and enhancing the experience of healthcare users, including physicians, patients, and members. In fact, payers reported substantial profits in Q1 2021. Higher enrollment in government plans drove growth, especially for Medicare Advantage (MA) plans, though commercial enrollment was still below pre-pandemic levels. Healthcare enterprises are realizing the need to build coordinated, integrated, and preventive care as they shift to value-based care and look to bring down costs while improving the quality of care. Payers are increasingly developing strategies to build new home-based health models, strengthen population health initiatives, and facilitate better coordination between different forms of care. This report examines payer performance in H1 2021. It focuses on industry- and account-level financial and Line of Business (LoB) performance. and key business and IT investment themes. Scope The report examines payer performance at an industry and account level. Industry: healthcare payer Geography: US Contents In this research, we: Provide a payer industry overview: financials, membership by LoB, business themes, and IT themes  Share account-specific insights: financials, membership by LoB, and account-specific themes Membership(s) Healthcare Payer and Provider Information Technology Sourcing and Vendor Management

The concept of interoperability is not new to the healthcare industry. Industry stakeholders have long debated the need and feasibility of interoperability within the healthcare ecosystem. The Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC) Interoperability and Patient Access Final Rule has provided the necessary encouragement to healthcare enterprises and IT vendors to bring together data and provide easy data access to members/patients to coordinate their healthcare. The final rule also facilitates data access between payers and between payers and providers, giving these entities a broader view into member/patient healthcare and enabling them to enhance member/patient engagement and improve care delivery. This viewpoint examines the evolution of interoperability in healthcare, provisions and timelines of the interoperability rule, areas that enterprises should focus on for regulatory compliance, additional investments required to reap long term benefits of the rule, and complexity of the supplier landscape. Scope Industry: healthcare Geography: US Contents: This report studies: Interoperability in healthcare – evolution and regulatory mandates Healthcare enterprises navigating interoperability The interoperability solution landscape Emerging investment areas for healthcare enterprises Membership(s) Healthcare Payer and Provider Information Technology Sourcing and Vendor Management

Digital healthcare refers to the use of technologies in the healthcare system to improve individuals’ health and wellness, and increase the efficiency of the entire healthcare value chain. The range of applications include, but are not limited to, practice management, care management, care financing, telehealth, clinical decision support, and patient/member engagement. Digital transformation is the first step toward a value-based and patient-focused approach to healthcare and can help healthcare providers streamline clinical workflow, increase healthcare accessibility, and offer a better user experience. Recognizing this need, multiple digital healthcare start-ups have emerged in the past decade and are constantly innovating to provide out-of-the-box solutions, optimize clinical workflows, improve healthcare data interoperability, and reduce care costs. In this research, we present an assessment of start-ups that offer digital healthcare solutions, focusing on their innovations, growth stories, and market impact. Scope Focus area: digital healthcare start-ups Industry: healthcare ITS Geography: US Contents This report studies: A market overview of the digital healthcare landscape Funding and M&A trends for digital healthcare start-ups Digital healthcare start-up categories An assessment of digital healthcare start-ups Trailblazers Membership (s) Healthcare Payer and Provider Information Technology Sourcing and Vendor Management

As enterprises ramp up their digital transformation initiatives, the strategic sourcing function faces the challenging task of establishing and orchestrating an IT services vendor portfolio that can help these companies fulfill their business objectives. This digital age sourcing model requires co-existence of distinct IT service provider roles to help enterprises balance multi-fold objectives such as risk management, modernization, and building capabilities across change, manage, and run initiatives. The underlying principle of this framework is that deriving business value from IT requires enterprises to have access to best-of-breed capabilities across a broad set of themes. As part of this shift, there is a need to look at the specialist ecosystem. In this viewpoint, we highlight why specialists are important and how an increasing number of enterprises have realized the need for technological, functional/methodological, and industrial expertise to add value to business and technology transformation initiatives. We also cover the challenges associated with specialists that enterprises need to be aware of and provide a checklist of key metrics for evaluating and identifying the right specialist. Scope Industry: IT services Geography: Global Contents: This report looks at: Need for evolved sourcing models Growing relevance of specialists Need to identify the right specialist Assessment of specialists – checklist Membership(s) Application Services Banking Information Technology Cloud & Infrastructure Services Digital Services Enterprise Platform Services (EPS) Healthcare Payer and Provider Information Technology Insurance Information Technology Life Sciences Information Technology

The pandemic has led to sweeping changes in who receives care, how they access it, and how healthcare organizations (healthcare providers, payers, and community resources) come together to meet the complex and accelerated demand for care, while dealing with provider burnout, customer distrust, and financial turmoil. Healthcare payers have faced critical challenges such as disruption of member service operations and administrative inefficiencies around provider network management/coordination, member communication, and claims management. This report evaluates payer performance in H2 2020 and focuses on industry- and account-level financial and LoB performance, key business and IT investment themes, and the Global Business Services (GBS) landscape. Scope Industry: healthcare payer Geography: US Contents This report provides: Payer industry overview: financials, membership by LoB, business themes, and IT themes, GIC landscape Account-specific insights: financials, membership by LoB, and account-specific themes Membership(s) Healthcare Payer and Provider Information Technology Sourcing and Vendor Management

On January 6, 2021, UnitedHealth Group’s Optum acquired Tennessee-based healthcare technology company Change Healthcare for roughly US$13 billion (including about US$5 billion debt). Upon the deal’s completion in H2 2021, Change Healthcare will become a part of OptumInsight, Optum’s data and analytics arm. The acquisition promises to make Optum a partner of choice for enterprises, especially in areas where both Optum and Change Healthcare are dominant, such as payment integrity, Revenue Cycle Management (RCM), and data analytics. The acquisition is also expected to provide more mature, comprehensive, and end-to-end solutions; however, how the firms leverage their combined position in the future will be vital to serving enterprise clients. This viewpoint analyses the acquisition in detail, identifying the key drivers, the acquisition’s implications on healthcare industry stakeholders, post-acquisition considerations, and Everest Group’s views on the healthcare industry’s future course as consolidation continues in the market. Membership(s) Healthcare IT Services (ITS) Healthcare Payer and Provider Business Process Sourcing and Vendor Management

The healthcare IT services space has historically been dominated by global service providers – including the likes of horizontal players such as Accenture, Cognizant, and TCS, as well as healthcare-specific giants such as Optum. However, in the past few years, the healthcare IT services supply ecosystem has evolved to include many small/midsized service providers. These service providers are establishing themselves as specialists in the healthcare IT services domain and gaining strong foothold in the market. A few have started challenging the front runners directly, while others are creating a niche for themselves in specific pockets. In a nutshell, these players are leveraging their healthcare domain expertise, healthcare services specialization, or/and high client intimacy to gain market share. In this study, we focus on IT service providers valued at not more than US$1 billion, receiving 25% or more of their revenue from healthcare, and falling under one or more of the following three buckets: broader healthcare IT service providers, healthcare platform-specific service providers, and healthcare consulting service providers. We assess 12 healthcare IT service specialists featured on the Healthcare IT Services Specialists PEAK Matrix® and categorize them into Leaders, Contenders, and Major Aspirants based on their capabilities and market impact. Our assessment is based on Everest Group’s annual RFI process for the calendar year 2020, interactions with specialists, client reference checks, and an in-depth analysis of the healthcare IT services market. Scope This research assesses the following healthcare IT services specialists: CitiusTech, Cumberland Consulting, emids, GAVS, Healthcare IT Leaders, Huron Consulting Group, Impact Advisors, Infinite, Infostretch, Nordic Consulting, Optimum Healthcare IT, and Pivot Point Consulting. Contents This report features detailed assessments of 12 healthcare IT services specialists, along with their strengths and areas of improvement. Membership(s)Healthcare IT Services (ITS) Sourcing and Vendor Management