Claims processing is becoming ever more complex for payers given issues such as the need to transform healthcare plans’ business models to accommodate new markets and new lines of business; and increasing inflow of members; and, increasing regulatory mandates. Payment integrity is a potential help – in can reduce rising healthcare waste and fraud to ensure that the medical claims are paid correctly and free of wasteful and abusive practices. Payers’ traditional pay and chase approach has resulted in provider abrasion and has limited the recovery of over-/incorrectly paid claims. Payment integrity product vendors provide solutions that analyze a claim in both the pre- and post-submission phases, using advanced analytics and data mining tools and solutions. They use patterns identified across billions of lines of claims to predict errors, helping payers make required corrections before processing claims. In this report, we analyze 11 payment integrity solutions vendors’ capabilities and map them on the Everest Group PEAK Matrix™, a composite index of distinct metrics related to a vendor’s vision & capability and market impact. This report offers: Market trends for payment integrity and the associated solutions market Information on the payment integrity solutions vendor landscape An assessment of the vendors on several vision & capability- and market impact-related dimensions Vendors covered:Burgess, Change Healthcare, ClarisHealth, Cotiviti, EXL, FICO, FraudLens, HMS, IBM (Truven), LexisNexis, and Optum Scope of this report: Industry: Healthcare payers Services: Payment integrity solutions Geography: US Content: This report has four key sections, each containing insights into the payment integrity solutions landscape: Summary of key messages Payment integrity solutions – market overview PEAK Matrix for payment integrity solutions, which maps vendors on the Everest Group PEAK Matrix and analyzes individual vendor capabilities along the following dimensions: Vision and capability Vision and strategy Technology capability Services capability Innovation and investments Engagement and commercial model Market impact Market adoption Portfolio mix Value delivered Profiles of payment integrity solution vendors: Vendor vision and strategy related to payment integrity solutions General overview of the vendor’s payment integrity solutions business – scale, overall focus, scope, and extent of adoption across enterprise lines of business, processes, and buyer sizes Overview of the vendor’s payment integrity solutions Assessment of the vendor’s payment integrity domain investments and innovative initiatives, and partnerships/alliances Memebership(s) Healthcare IT Services (ITS)

The payer industry is facing several issues such as escalating costs, declining margins, widespread regulatory amendments, shift from volume- to value-based care model, and rising consumerism. Digital adoption is influencing all aspects of the payer value chain. Payers are focusing on approaching key value chain areas – product discovery (enrollment and risk profiling), medical intervention, and coordinated care (claims management and member follow-ups) – with digital initiatives to create a differentiated impact. Enterprises have made digital adoption the bedrock of their growth strategy in the recent years, to optimize processes, reduce costs, and deliver better customer experience, all in the pursuit of higher revenue growth. The healthcare payer industry is no exception to this. Digital technologies can make internal workflows more efficient, bring care outside hospitals, offer network management transparency & efficiency, and help reduce frauds. To support enterprises on their digital journeys, service providers are ramping up capabilities through healthcare-specific partnerships and acquisitions. This, in turn, is driving the need for research and market intelligence specific to demand and supply trends in healthcare payer digital services. Everest Group’s healthcare ITS research program addresses this market need by analyzing outsourcing trends and service provider capabilities in healthcare digital services. In this research, we present an assessment and detailed profiles of 23 digital service providers for the healthcare payer industry, featured on our healthcare payer digital services PEAK Matrix™. Our assessment is based on Everest Group’s annual RFI process for the calendar year 2019, interactions with leading digital service providers, client reference checks, and an in-depth analysis of the digital services market. Service providers covered: Accenture, Atos, Capgemini, CGI, Citius Tech, Cognizant, Conduent, DXC Technology, emids, EPAM, HCL Technologies, Hexaware, HTC Global Services, IBM, Infosys, Mphasis, NTT DATA, Optum, TCS, Tech Mahindra, UST Global, Virtusa, and Wipro Scope Industry: healthcare payers Services: digital services Geography: global Sourcing model: third-party ITS transactions; excludes shared services or Global In-house Centers (GICs) Contents This report comprises an executive summary and three sections, each containing insights about the healthcare payer digital service providers’ landscape, as outlined below: Summary of key messages Healthcare payer digital services trends PEAK Matrix assessment of healthcare payer digital service providers Profiles of 23 healthcare payer digital service providers Membership(s) Healthcare IT Services (ITS)

Historically, healthcare providers have been impeded by legacy IT estate and regulations that have sought to maintain the status quo. However, that is not an option anymore, particularly as healthcare providers scramble to meet the unprecedented needs exacerbated by the COVID-19 pandemic. They are now jumping on the digital bandwagon to meet the demands of a challenged healthcare ecosystem. To support enterprises on their digital journeys, service providers are ramping up capabilities, driving up the need for research and market intelligence on demand and supply trends in healthcare provider digital services. Everest Group’s Healthcare ITS research program addresses this market need by analyzing demand themes and service provider capabilities in healthcare provider digital services. In this research, we present an assessment of 22 healthcare digital service providers, featured on our Healthcare Provider Digital Services PEAK Matrix® Assessment 2020. Our assessment is based on Everest Group’s annual RFI process for the calendar year 2020, interactions with leading digital service providers, client reference checks, and an in-depth analysis of the digital services market. Scope Industry: healthcare providers Services: digital services Geography: global Service providers covered: Accenture, Atos, Capgemini, Deloitte, CitiusTech, Cognizant, DXC Technology, emids, EPAM, GAVS, HCL Technologies, Hexaware, HTC Global Services, IBM, Infinite, Infostretch, NTT DATA, Optum, TCS, Tech Mahindra, Virtusa, and Wipro Contents This report comprises three sections, each containing insights about the healthcare digital service providers’ landscape, as outlined below: Provider digital services market update PEAK Matrix® assessment of healthcare provider digital services Everest Group’s remarks on service providers Membership(s)Healthcare IT Services (ITS)

The healthcare industry has experienced an exponential rise in data, following the adoption of smartphones, wearables, and electronic health records, which can revolutionize the healthcare industry. Healthcare organizations are monetizing this data to generate revenue, reduce costs, and improve clinical care outcomes. They can either directly sell this data or use it to draw insights to enhance their internal operations. The larger ecosystem, in turn, benefits by the enhanced clinical results derived from this data. In fact, several startups are using data to test their new innovations and deliver better therapies and care. In this report, we study four key data monetization models in use presently – bilateral data exchange, open platforms for data exchange, open marketplaces for data exchange, and open marketplaces for patients to sell data. We also analyze current adoption and the scope of scaling these models. We believe that while the benefits of monetizing data are many, the privacy and security challenges accompanying it cannot be ignored and need to be addressed at the earliest. Scope Geography: global Industry: healthcare Sources leveraged: expert analyst inputs, Everest Group research, publicly available secondary data sources Contents In this research, we: Define data monetization in healthcare Study four key models of data monetization in healthcare Understand the privacy and security challenges accompanying healthcare data monetization Membership(s) Healthcare IT Services (ITS) Data & Analytics

Historically, healthcare providers have been impeded by legacy IT estate and regulations that have sought to maintain the status quo. However, the COVID-19 pandemic has compelled them to jump on the digital bandwagon to meet the demands of a challenged healthcare ecosystem. To support healthcare providers on their digital journeys, service providers are ramping up their capabilities, driving up the need for research and market intelligence on demand and supply trends in healthcare provider digital services. Everest Group’s Healthcare ITS research program addresses this market need by analyzing demand themes and service provider capabilities in healthcare provider digital services. In this research, we present detailed profiles of 22 healthcare digital service providers, featured on the Healthcare Provider Digital Services PEAK Matrix® Assessment 2020. Our assessment is based on Everest Group’s annual RFI process for the calendar year 2020, interactions with leading digital service providers, client reference checks, and an in-depth analysis of the digital services market. Scope Geography: global Industry: healthcare providers Services: digital services Service providers covered: Accenture, Atos, Capgemini, Deloitte, CitiusTech, Cognizant, DXC Technology, emids, EPAM, GAVS, HCL Technologies, Hexaware, HTC Global Services, IBM, Infinite, Infostretch, NTT DATA, Optum, TCS, Tech Mahindra, Virtusa, and Wipro Contents This report comprises two sections: PEAK Matrix® assessment of healthcare provider digital services Detailed profiles of 22 healthcare digital service providers Membership(s) Healthcare IT Services (ITS)

Today, healthcare enterprises are looking to leverage Salesforce to not just engage with patients, but for their end-to-end business functions and to address broader healthcare needs, such as reducing technical debt, containing costs, driving patient centricity, and enabling data interoperability. Healthcare enterprises seek to create a 360-degree patient/member view by leveraging advanced analytics to better engage with and offer personalized experiences to patients/members, improve care outcomes, and drive cost efficiencies. With these changing enterprise expectations and the evolving Salesforce technology landscape, service providers are building strong healthcare-specific solutions to expedite their clients’ time-to-market and are taking a strong inorganic approach to fill gaps across their Salesforce services portfolios and enhance their geographic footprints. In this research, we present an assessment of 18 service providers featured on the Salesforce Healthcare Services PEAK Matrix®. The assessment is based on Everest Group’s annual Request For Information (RFI) process for the calendar year 2020, interactions with leading Salesforce service providers, client reference checks, and an ongoing analysis of the Salesforce services market. Scope This research assesses the following IT service providers / system integrators associated with Salesforce healthcare services: Accenture, Acumen Solutions, Coastal Cloud, Cognizant, Customertimes, Deloitte, IBM, Infosys, NTT DATA, Penrod, Persistent Systems, PwC, Silverline CRM, TCS, Torrent Consulting, Virsys12, Virtusa, and Wipro. Contents This report features detailed assessments of 18 Salesforce healthcare service providers, along with their strengths and areas of improvement. Membership(s)Healthcare IT Services (ITS) Sourcing and Vendor Management

The healthcare provider industry has been plagued with numerous issues – care providers have been operating on thin margins due to high claims denials, increasing bad debts, and the higher cost of operations, partially because of the lack of integration between multiple clinical and revenue cycle platforms. COVID-19 has further added to their woes, with the deferral of elective procedures and a rising number of uninsured and unemployed population, affecting their collections and, consequently, margins. Moreover, with telehealth coming under the spotlight, providers are struggling to come up with a clear strategy to enable virtual health. Thus, buyers are seeking third-party support to address these challenges through multiple engagement models, such as software, services, and solutions. In particular, the Revenue Cycle Management (RCM) solutions engagement model is gaining traction due to its ability to offer customized solutions to healthcare providers. Consequently, many service providers / vendors are building their capabilities in the market. Scope Industry: RCM solutions Service providers / vendors studied: AdvancedMD, Allscripts, Apexon Health, Athenahealth, Availity, Cerner, Change Healthcare, Cognizant, Conifer Health, Epic, HGS, MedAssist (Firstsource), NextGen Healthcare, nThrive, Optum, Parallon, R1 RCM, and Waystar Contents In this report, we focus on: Key issues faced by healthcare providers Key outsourcing trends in the RCM solutions market The RCM solutions outsourcing service provider / vendor landscape Membership(s) Healthcare Payer and Provider Business Process Healthcare Payer and Provider Information Technology Sourcing and Vendor Management

Early adopters of Salesforce services were looking to effectively manage customer relationships, market targeted products, explore sales performance, and drive cost efficiencies on the cloud. With the expansion of Salesforce’s technology landscape, enterprises’ approach toward Salesforce has evolved from reactive relationship management to a proactive approach toward Customer Experience (CX). Healthcare enterprises are looking to leverage Salesforce to not just engage with patients, but for their end-to-end business functions and to address broader healthcare needs such as reducing technical debt, containing costs, driving patient centricity, and achieving data interoperability. Thus, service providers are investing in building strong healthcare-specific solutions to expedite time-to-market for their clients and are taking a strong inorganic approach with tuck-in acquisitions to fill gaps across their Salesforce services portfolios and further enhance their geographic footprint. In this research, we present an assessment of 18 service providers featured on the Salesforce Healthcare Services PEAK Matrix®. The assessment is based on Everest Group’s annual Request For Information (RFI) process for calendar year 2020, interactions with leading Salesforce service providers, client reference checks, and an ongoing analysis of the Salesforce services market. Scope This research covers the following IT service providers / system integrators associated with Salesforce healthcare services: Accenture, Acumen Solutions, Coastal Cloud, Cognizant, Customertimes, Deloitte, IBM, Infosys, NTT DATA, Penrod, Persistent Systems, PwC, Silverline CRM, TCS, Torrent Consulting, Virsys12, Virtusa, and Wipro. Contents This report features detailed assessments of 18 Salesforce healthcare service providers, along with their strengths and areas of improvement. Membership(s)Healthcare IT Services (ITS) Sourcing and Vendor Management

Today, healthcare enterprises are looking to leverage Salesforce to not just engage with patients, but for their end-to-end business functions and broader healthcare needs, such as reducing technical debt, containing costs, driving patient centricity, and enabling data interoperability. Healthcare enterprises seek to create a 360-degree patient/member view by leveraging advanced analytics to better engage with and offer personalized experiences to patients/members, improve care outcomes, and drive cost efficiencies. With these changing enterprise expectations and the evolving Salesforce technology landscape, service providers are building strong healthcare-specific solutions to expedite their clients’ time-to-market and are taking an inorganic approach to fill gaps across their Salesforce services portfolios and enhance their geographic footprints. In this report, we share our insights on market trends for Salesforce services. We also study buyer expectations and key challenges faced by enterprises based on our ongoing interactions. Scope: The report looks at the entire range of services provided for Salesforce products, including consulting and advisory, custom app development, implementation and integration, and maintenance and support. Industry: healthcare ITS Geography: global Contents: This report studies: Global Salesforce services market size and growth Adoption trends Buyer expectations Implications for service providers Membership(s) Healthcare IT Services (ITS) Sourcing and Vendor Management

For a very long time, the healthcare industry has overlooked the experience of its consumers, who are now demanding an experience similar to industries such as retail or banking. Realizing this growing need, consumer experience has become an executive-level priority in the last couple of years, with most healthcare leaders agreeing that they are in the business of selling an experience and not a product. To address this need, healthcare payers are investing in consumer experience technologies that can help them acquire and retain consumers by making an impact on every aspect of the consumer journey. Improved member experience is a win-win solution for members as well as payers, as it can improve payer finances, reduce administrative costs, and enhance the quality of care. In this research, we deep dive into the rise of customer experience solutions, analyze the different kinds of offerings, and compare platforms available in the market based on their ability to meet payer needs. Scope Industry: healthcare Geography: global Contents: In this research, we focus on: The focus on member experience Evolution of member experience solutions Key vendor landscape Membership (s) Healthcare Payer and Provider Information Technology Sourcing and Vendor Management