The Payment Integrity (PI) market is structurally resetting. Payers are moving from retrospective audits to preventive, pre-payment validation using AI, predictive analytics, and automation to detect anomalies early, improve coding accuracy, and reduce provider abrasion. This prevention-first posture aligns with value-based care and targets lower medical loss ratios, fewer takebacks, and audit-ready defensibility while improving efficiency. Modernizing buyers prioritize outcome-linked pricing, real-time reporting, appeals overturn rates, overpayment and error identification, and domain expertise. They also value flexible deployments, modular platforms, and co-sourced models that augment teams. Transparent payer–provider workflows and data reduce disputes and enable right-first-time payments. This report screens more than 50 PI solution providers, shortlists 18 niche specialists, and profiles 10 high-potential specialists. It features detailed profiles of the 10 high-potential specialists, including company overviews, key executives, core elements, PI offerings, and selected metrics such as year of incorporation, headquarters, and employee count. Everest Group also shares its perspective on each specialist’s business maturity, domain focus, market buzz, technology, leadership, and talent.

Population Health Management (PHM) is a cornerstone of modern healthcare, enabling payers and providers to improve outcomes and reduce costs by proactively managing patient populations. As the burden of chronic disease, aging populations, and health inequities rises, PHM platforms provide structured, data-driven frameworks to support early intervention, coordinated care, and improved quality scores. The shift to value-based care is accelerating demand for PHM solutions that integrate diverse data sources, from EHRs and labs to claims, wearables, and Social Determinants of Health (SDoH). Despite significant progress, adoption challenges remain around interoperability, workflow integration, and costs. Payers and providers increasingly prioritize solutions that offer scalability, bidirectional FHIR-based data exchange, configurable workflows, and actionable insights. Platform providers are differentiating through AI-powered outreach, advanced equity analytics, and quality measure tracking integrated directly into EMRs. The report evaluates 20 leading global PHM platform providers across a range of core capabilities, including data unification and integration, risk stratification, care coordination, patient engagement, real-time analytics, and the incorporation of SDoH. It also explores how these platforms leverage next-generation technologies such as AI to generate intelligent insights and drive early interventions. In addition, the report features detailed profiles of each provider, outlining platform functionalities and highlighting case studies. Everest Group also shares its perspective on each provider’s market impact, innovation maturity, and capability depth.

Healthcare organizations generate massive data volumes from EHRs, IoT, labs, and billing systems, making effective data management essential. Interoperability, governance, and real-time analytics challenges hinder seamless data flow and insight generation. Healthcare data platforms address these issues by offering AI-driven analytics, ETL pipelines, and EHR connectivity, transforming raw data into actionable insights. These platforms improve operational efficiency, enhance patient outcomes, and enable data-driven decision-making. However, balancing innovation with compliance remains vital as organizations navigate regulatory complexities and privacy concerns. Advanced solutions ensure secure, scalable, and intelligent data management, enabling predictive analytics and real-time interoperability. As the healthcare landscape evolves, data platforms will be pivotal in optimizing workflows, streamlining care coordination, and driving digital transformation across the industry. In this report, we analyze the data platforms landscape, including key solution components, considerations to select the right tool, and leading providers. It highlights healthcare data platforms’ evolution from traditional data storage to AI-driven analytics, real-time interoperability, and predictive insights. The report profiles 15 leading technology providers that offer data platforms, highlighting their capabilities and industry use cases. Scope Industry: healthcare Domain: healthcare data platforms Geography: global Contents In this report, we provide: Each provider’s company overview Provider’s capability, market trends, and innovation dimensions Case studies demonstrating capabilities in the healthcare data management space Membership(s) Healthcare Payer and Provider Information Technology Sourcing and Vendor Management