Research Director, Payer IT Strategies
Major Players
Availity
InterSystemsFeatured Vendor
Quest Analytics
Santéch Software
symplr
Leaders
LexisNexis
Contenders
Virsys12
This IDC study represents the vendor assessment model called IDC MarketScape. This research is a quantitative and qualitative assessment of the characteristics that explain a vendor’s current and future success. This study assesses the capability and business strategy of many of the most prominent provider data management (PDM) vendors found in payers that use that software to establish a “core provider system of record or truth” for the payer enterprise. This evaluation is based on a comprehensive framework and a set of parameters expected to be most conducive to success in providing provider data management software today and in the future. A significant and unique component of this evaluation is the inclusion of buyers’ perception of both the key characteristics and capabilities of these vendors. Interest in reengineering and automating payers’ “provider back office” is stimulated by the evolutionary change of value-based reimbursement provider contracts, the availability of enterprise workflow software, lightweight cloud models of operations proven by cooperatives and start-up health plans, and enhanced document management capabilities. A summary of findings of this study include:
When purchasing provider data management software, consider these recommendations:
This section explains IDC’s key observations resulting in a vendor’s position in the IDC MarketScape. While every vendor is evaluated against each of the criteria outlined in the Appendix, the description here provides a summary of each vendor’s strengths and challenges.
IDC’s assessment includes seven vendors: Availity, InterSystems, LexisNexis Risk Solutions, Quest Analytics, Santéch Software, symplr, and Virsys12. Other vendors did not meet the inclusion criteria and they will be highlighted in an upcoming document featuring the vendors to watch for provider data management in 2022. Those vendors are NTT DATA, Ribbon Health, Salesforce, SKYGEN, and Simplify Healthcare.
According to IDC analysis and buyer perception, InterSystems is positioned in the Major Players category in this IDC MarketScape for provider data management for payers software in the U.S. market for 2022.
InterSystems, a global player in information technology platforms for health, finance, and government applications, founded in 1978, and serving payers since 2005, is privately held and offers HealthShare as one of its product suites. InterSystems has been providing interoperability solutions for decades internationally for many industries. Its ability to atomize, aggregate, deduplicate, and normalize data clearly is and has been its focus.
HealthShare is a suite of connected health solutions, and Provider Directory is a standalone purchasable unit that has been in the suite since 2019. It alternatively can be used within HealthShare as a directory FHIR resource and to maintain a provider registry for notifications. For example, a HealthShare buyer could purchase the following individual products:
HealthShare Provider Directory, introduced in 2019-2020, on premises or hosted, focuses on master data management. Its data model and its understanding of the interoperability between payers and providers is its strength. Its core solution centers on the following key functionalities: data ingestion; data preparation and cleaning/normalizing; parsing data into the data model; matching and linking based on customizable rules; operational data management, such as validating matches, running queries, and updating records; and sharing and exporting data in multiple formats including FHIR.
HealthShare Provider Directory also offers a provider identity matching engine that combines deterministic matching, probabilistic algorithms, and defined rules to create, manage, and maintain the complex relationships that define the healthcare landscape, such as organization hierarchies, network participation, and multiple practice locations for provider information. Its Provider Directory is built on the HealthShare platform that includes interoperability tools combined with a push service that maintains a directory FHIR repository and can supply master data management records’ updates to downstream systems with accurate, up-to-date, reliable information.
InterSystems offers an on-premises or cloud solution in a “per provider” pricing model.
For data ingestion, HealthShare uses a suite of tools to enable interoperability among and onboarding of healthcare systems. Key tools in the ingestion process are:
HealthShare processes inbound records as data events, allowing rules-based action triggers based on transactions flowing through the system. As data is ingested, it is also made available in a relational data model for operational reporting and analysis.
Regarding curation of data, HealthShare ensures the consistency of data in several ways:
InterSystems is extremely experienced in health data and its management. Its preexisting adapters for mapping standard data formats that facilitate data onboard show its commitment to (international) standards, and it serves on standards bodies (DaVinci, DEQM, Carin, INTEROPen, FHIR, HL7, and IHE). Tangentially, it is notable that EPIC relies on InterSystems development technology for its EHR software and expertise in infusing data into the EHR workflow. It also serves as the engine for 12 state health information exchanges (HIE) and the eHealth Exchange. The eHealth Exchange is active in all 50 states, is the oldest and largest national health information network in the United States, and is the principal network that connects federal agencies and nonfederal organizations, including over 75% of U.S. hospitals and tens of thousands of clinics, to share patient records to better treat patients and coordinate care. This shows its expertise in scalable bidirectional data exchange and an understanding of standards, certifications, and state regulation.
InterSystems does not support campaigns for recruiting, onboarding, search (although it has REST and FHIR API implementation guides), outreach, attestation, self-service, CAQH/SAM/PECOS/LexisNexis validations, network adequacy, provider ratings, or sanctions, but these are on its road map and the data model is extensible.
InterSystems’ focus is on cleansing and identity so that the company’s core HealthShare applications and external interfaces have good provider data to execute with, including adherence to DaVinci methodology. InterSystems has an expertise in claims, enrollment, clinical, and SDoH data integration. Its slant on its provider data focus shows that lineage.
Consider InterSystems when you want a very health-oriented, international, experienced, data-centric, professional software vendor that understands the importance of clean data, governance, and the role of provider data integration in the interoperable health ecosystem. Its experience in HIE, payers, providers, finance, and government show its dedication to data engines providing accurate data as the commerce for better health.
This research includes analysis of seven software providers that offer both on-premises and cloud-based provider data management solutions to payers for their purpose of contracting with providers. IDC believes that the vendors in this study generate most of the revenue in this market.
The increasing depth and breadth of the data that consumers require from their provider directories, the explosion of new provider types under wellness or specialty care themes, the maturation of value-based reimbursement, and the strategic payer advantage of establishing narrow networks cause a rethink of the provider data management software market. Vendors were polled and were included based on meeting the majority of following criteria:
There are a variety of vendors around the broader “provider relationship management” space. The focus of this research is around the core administrative system that provides a “source of provider truth” for the enterprise. Therefore, this scope specifically excludes contract management, product assignment, credentialing, fee schedule management, network modeling, contact management, provider relations, provider quality management, contract monitoring, and visits management.
For the purposes of this analysis, IDC divided potential key measures for success into two primary categories: capabilities and strategies.
Positioning on the y-axis reflects the vendor’s current capabilities and menu of services and how well aligned the vendor is to customer needs. The capabilities category focuses on the capabilities of the company and product today, here and now. Under this category, IDC analysts will look at how well a vendor is building/delivering capabilities that enable it to execute its chosen strategy in the market.
Positioning on the x-axis, or strategies axis, indicates how well the vendor’s future strategy aligns with what customers will require in three to five years. The strategies category focuses on high-level decisions and underlying assumptions about offerings, customer segments, and business and go-to-market plans for the next three to five years.
The size of the individual vendor markers in the IDC MarketScape represents the market share of each individual vendor within the specific market segment being assessed. Critical to a successful vendor selection is the articulation of the priorities and strategy of the purchasing organization.
Recognize that a vendor’s market share as represented in this document is a snapshot in time and may not reflect its near-term growth or consider its experience and success with related legacy products. A vendor’s market share should be considered when evaluating the relative risk of a relationship with a vendor. For example, if a vendor’s product has been active in the market for 10 years and has fewer than 20 clients further, due diligence is required.
The IDC MarketScape is a valuable representation by a neutral third party of a vendor’s current capabilities and future strategy. The IDC MarketScape should not be used in a vacuum but rather be one of several inputs to short listing vendors.
IDC MarketScape criteria selection, weightings, and vendor scores represent well-researched IDC judgment about the market and specific vendors. IDC analysts tailor the range of standard characteristics by which vendors are measured through structured discussions, surveys, and interviews with market leaders, participants, and end users. Market weightings are based on user interviews, buyer surveys, and the input of IDC experts in each market. IDC analysts base individual vendor scores, and ultimately vendor positions on the IDC MarketScape, on detailed surveys and interviews with the vendors, publicly available information, and end-user experiences in an effort to provide an accurate and consistent assessment of each vendor’s characteristics, behavior, and capability.
Provider data management in the payers’ back office involves creating a “system of truth” for provider data in a payer organization. Concerns include demographic data capture, facilitating provider relations, enabling network formulation, establishing a provider relationship, credentialing, contracting, and directory publication as well as enabling the rest of the organization to refer to the system of truth for reference.
