Top Outsourcing Services Vendors

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1 BLACK BOOK MARKET RESEARCH 2016 USER SURVEY Top Outsourcing Services Vendors Revenue Cycle Management & Analytics Healthcare Chains, Systems, Corporations & IDNs Survey Period: Q Q BLACK BOOK TOP HOSPITAL REVENUE CYCLE MANAGEMENT & ANALYTICS TECHNOLOGY VENDORS Published September

2 Black Book annually evaluates leading health care/medical software and outsourcing service providers across 18 operational excellence key performance indicators completely from the perspective of the client experience. Independent and unbiased from vendor influence, more than 428,000 healthcare IT users are invited to contribute to various annual customer satisfaction polls. Suppliers also encourage their clients to participate to produce current and objective customer service data for buyers, analysts, investors, consultants, competitive suppliers and the media. For more information or to order customized research results, please contact the Client Resource Center at or FIERCELY INDEPENDENT Black Book, its founders, management and staff do not own or hold any financial interest in any of the vendors covered and encompassed in the surveys it conducts. Black Book reports the results of the collected satisfaction and client experience rankings in publication and to media prior to vendor notification of rating results and does not solicit vendor participation fees, review fees, inclusion or briefing charges, and/or vendor Black Book Market Research LLC, All Rights Reserved. Reproduction of this publication in any form without prior written permission is forbidden. The information contained herein has been obtained from sources believed to be reliable. Brown-Wilson Group, Inc. the parent corporation of Black Book, Black Book Market Research LLC, Black Book Market Research LLC, and The Black Book of Outsourcing, disclaims all warranties as to the accuracy, completeness or adequacy of such information. Brown-Wilson Group shall have no liability for errors, omissions or inadequacies in the information contained herein or for interpretations thereof. The reader assumes sole responsibility for the selection of these materials to achieve its intended results. The opinions expressed herein are subject to change without notice. Brown-Wilson Group's unrivaled objectivity and credibility is perhaps your greatest assurance. At a time when alliances between major consultancies and suppliers have clouded the landscape, Brown-Wilson Group remains resolutely independent. We have no incentive to recommend specific software or outsourcing services vendors. Our only allegiance is to help you achieve the results you want with the best possible solution. For more information, visit 2

3 Table of Contents 2016 BLACK BOOK HOSPITAL REVENUE CYCLE TECHNOLOGY OUTSOURCING SURVEY OVERVIEW INTRODUCTION 6-17 Key Findings 6 Survey Overview 17 BLACK BOOK METHODOLOGY How the data sets are collected 18 Understanding the statistical confidence of Black Book data 18 Who participates in the Black Book ranking process? 19 Hospital Revenue Cycle Management software and technology vendor rankings and results COMPARATIVE VENDOR ANALYSIS TOP 20 HOSPITAL REVENUE CYCLE MANAGEMENT OUTSOURCING VENDORS 15 Top #1 Hospital RCM vendor overall, top vendors by four functional subsets Top 20 Hospital RCM vendors, ranked list 1 through 20 STOP LIGHT SCORING KEY 20 OVERALL KPI LEADERS 24 Summary of criteria outcomes 25 Top score per individual criteria 26 INDIVIDUAL KEY PERFORMANCE 27 APPENDIX 47 A division of Brown Wilson Group Inc., Black Book Research 47 Disclaimer 47 3

4 Table of Figures Figure 1 : Comprehensive Hospital RCM Outsourcing vendors defined 20 Figure 2 : Key to raw scores 21 Figure 3 : Color-coded stop light dashboard scoring key 22 Figure 4 : Raw score compilation and scale of reference 23 Figure 5 : Scoring key 24 4

5 Table of Tables Table 1 : Top 20 Hospital Revenue Cycle Management Outsourcing Vendors Table 2 : Summary of criteria outcomes 26 Table 3 : Top score per individual criteria 28 Tables of Individual Key Performance Indicator, Top Ten Highest Mean by KPI Table 4 : Strategic Alignment 29 Table 5 : Innovation 30 Table 6 : Training 31 Table 7 : Client relationships and cultural fit 32 Table 8 : Trust, Accountability, Ethics and Transparency 33 Table 9 : Breadth of offerings, client types, delivery excellence 34 Table 10 : Deployment and implementation 35 Table 11 : Customization 36 Table 12 : Integration and interfaces 37 Table 13 : Scalability, client adaptability, flexible pricing 38 Table 14 : Compensation and employee performance 39 Table 15 : Reliability 40 Table 16 : Brand image and marketing communications 41 Table 17 : Marginal value adds 42 Table 18 : Viability, Managerial Stability 43 Table 19 : Data security and backup services 44 Table 20 : Support and customer care 45 Table 21 : Best of breed technology and process improvement 46 5

6 PART ONE : INTRODUCTION Black Book gathers insights via an interactive online survey and related telephone discussions and follow-up polling. The result is intended to serve as an annual barometer of the IT client satisfaction and managed services experience of medical groups, hospitals, clinicians, physicians, administrators, financial officers and technology professionals in the healthcare industry. The largest user opinion poll of its kind in healthcare Black Book collects over a half million viewpoints on information technology vendor performance annually. In this segmented survey of healthcare financial leaders, over 8,000 respective administrative/financial/technology support staff of hospitals and physician practices contributed their perceptions to Black Book between March 2016 and August 2016 to measure outcomes and performance in the Revenue Cycle Management, Patient Accounting, Coding, HIS/CIS and Electronic Health Record technology continuum. In a series of four research segments on the 2016 State of the Revenue Cycle Management industry, Black Book is releasing comprehensive findings of users on the trends and directions of hospitals and physician practices, as well as the top ranked vendors in customer satisfaction and client experience. Included in the 2016 Black Book Revenue Cycle Management survey sets released in Q4 are: Physician Integrated EHR/Practice Management/Revenue Cycle Management Software (1) Physician Practices Seamless PM/RCM/EHR Software Hospital Revenue Cycle Management Software (2) Large Hospital and Academic Medical Center RCM Software; and (3) Small and Community Hospital RCM Software Outsourcing RCM Services (4) RCM Outsourcing in Hospital Systems/IDNs/Systems/Chains; (5) RCM Outsourcing in Large Hospitals/Academic Medical Centers/Faculty Practices & Clinics over 200 Beds; (6) RCM Outsourcing in Community and Small/Rural Hospitals under 200 Beds, and (7) RCM Outsourcing for Physician Groups Revenue Cycle Consultants and Transformation Experts (8) RCM Consultants Computer Assisted Coding and Medical Record Outsourcing Services are announced in a separate Black Book survey result set also in Q4. 6

7 STATE OF HOSPITAL REVENUE CYCLE INNOVATION Revenue cycle management (RCM) is the life force of any hospital, private or nonprofit. Effective patient registration, insurance and benefit verification, charge capture, coding, and claims processing are essential to maintaining viability. In a marketplace of several hundred core and niche Revenue cycle management (RCM) vendors, Black Book survey respondent s evaluated 129 technology services /solutions. Many vendors offer both software and outsourced business services, while some only focus on one specialty. This report s vendor results center on software, technology and SaaS solutions only. RCM software applications are usually characterized in two segments - Core, Platform and/or Point Solutions - Bolt-on Solutions (providing added functionality to core solutions) The current penetration of RCM solutions for inpatient medical/surgical hospital environment varies by type of application. Software applications and outsourcing services needed for the core functions of patient registration, scheduling, billing, coding, and claims processing are adopted in 100% of hospitals today, while other RCM applications are less penetrated or significantly vary in penetration across various types of hospitals. The following represent aggregate findings from the five month polling process: Difficulty in Finding Skilled RCM Human Resources for New RCM Software/Reimbursement Challenges HOSPITAL SIZE CFO/Finance Director/ Business Office Management Experiencing Recruitment and Trained Staffing Issues with new RCM implementation Small/Rural Hospitals under 100 Beds 89% Community Hospitals Beds 69% Large Hospitals & Academic Medical Centers over 200 Beds 42% Hospital Chain, Systems, Shared Services, Networks and ACOs 37% 7

8 Staffing Concerns make Outsourcing core or bolt-on RCM services a better short term alternative to Software Implementations HOSPITAL SIZE CFO/Business Office Manager Agrees/ YES Small/Rural Hospitals under 100 Beds 82% Community Hospitals Beds 35% Large Hospitals & Academic Medical Centers over 200Beds 59% Hospital Chain, Systems, Shared Services, Networks and ACOs 47% What is your facilities top-related technology issue impacting total organizational revenue? HOSPITAL SIZE ICD-10 Coding EHR & Clinical Integrations Billing & Claims Contractual Analysis Interoperability Small/Rural Hospitals 44% 11% 21% 8% 16% Community Hospitals 28% 9% 38% 14% 11% Large Hospitals 13% 33% 14% 18% 22% Hospital Chain, Systems 15% 11% 24% 20% 30% Which scenario best describes your hospital s RCM strategy for software and outsourcing services HOSPITAL SIZE One Core Legacy RCM Vendor Software Solution Seamless Array of Core and Bolt-on RCM Software Solutions Outsourcing RCM End-to-End Outsourcing One or More Functions or Divisions with Software Small/Rural Hospitals 3% 25% 27% 45% Community Hospitals 4% 43% 17% 36% Large Hospitals 6% 51% 4% 39% 8

9 Which scenario best describes your hospital s plan for maintaining an outsourced revenue cycle management solution or set of managed services solutions? HOSPITAL SIZE Short Term (12-18 Months) On Going Solution (18-36 Months) Long Term (36-60 Months) Small/Rural Hospitals 7% 60% 33% Community Hospitals 10% 70% 20% Large Hospitals 11% 61% 28% Roughly one-third (1,800 of all US hospitals) predicting in 2012 that they would replace their core RCM solution have still failed to initiate a comprehensible, sustainable RCM plan as of January More than 1,400 hospitals confirmed the activation of a new or renegotiated RCM solution/services agreement between January 2015 and July Myopic task forces on ICD-10 coding, physician practice EHR integration, siloed EHRs, lack of connectivity, poor interfaces and insurance verification/eligibility issues had taken priority over comprehensive RCM solution strategies, claimed 44% of those 1,800 hospital CFOs represented in the survey. Once functioning well among small hospitals and community facilities, the now under-optimal core legacy systems needed to be bolstered bolt on RCM solutions and coding systems. Then the EHR marketplace additionally complicated some clinical information integrations and offered very limited financial decision support. Small and community hospitals under 200 beds particularly braced for the impact of operating at a fiscal loss with inpatient revenues decreasing and costs rising, including the implementation costs of ICD-10 impacts and electronic health record implementations. Technologically advanced academic medical centers, larger inpatient facilities, hospital systems and chains, ACO organizations, and affiliated provider networks are also supporting and growing the bolt on market products, particularly eligibility and analytics, as they have adapted RCM strategies to value based reimbursement and complex contractual agreements with payers. The selection of outsourced solutions increased nearly two-fold between January 2015 and August 2016 for claims processing, coding and collections. Of the 40% of hospitals under 200 beds that delayed making an RCM transformation program functional until after coding transitions are complete and meaningful use checks are cashed, more than three quarters are now in the decision making stages of an RCM vendor selection. 95% of large hospitals over 200 beds considering RCM transformation initiatives expect to execute their plans before January % of hospital financial executives in hospitals under 200 beds are concerned that neglected RCM transformations by Q will likely cease to operate, as insurers move to pay for quality not services from a system that thrived on sickness to one that rewards wellness and health. 9

10 43% of CFOs in hospitals under 100 beds expect their RCM strategy will be selected solely on their CIS vendor relationship, compared to 10% of CFOs in larger facilities, from 56% last year. Hospital CFOs and CIOs are at odds with the prioritization of RCM above all other technology spends in 2016, as was the case in all Black Book surveys since Although 70% of CIOs and 92% of CFOs agree current RCM strategy needs to be assessed, updated, outsourced or replaced, the project implementation acquisition, timing and urgency differ. CFOs and CIOs also are polarizing on the organizational preference to manage fewer vendors and favor single-source clinical and financial software vendors. In a boomerang shift starting from a 2010 Black Book survey, 85% of CFOs were amenable to implementing a single source software vendor following the direction of the hospital s clinical information system selection committee. In 2016, the general sentiment of 13% of CFOs was they could make any RCM solution work if the hospital s clinical staff was satisfied with the health care delivery element of the system. In 2013, 77% of hospital CFOs held that opinion. The significant drop in CFO conciliation on this viewpoint is reflective of the implementation of functional (and replacement) EHRs. 92% of Chief Financial Officer s agree their strategic leadership to drive revenue cycle management technology and vendor selection is now taking priority in their hospitals and systems. The focus on EHR implementations and clinical analytics has shifted to the financial health of organizations, empowering CFOs to make technology and services decisions that are not encumbered or influenced by the status of EHRs or maintaining outdated systems waiting for available capital. In this Black Book survey ending in August 2016 of the same topic, barely 2% of CFOs want their RCM system or services decisions driven by other hospital leaders including CIOs and/or clinicians. Even in small hospitals under 100 beds, 96% of CFOs have strong preference for a best in breed RCM vendor, regardless of the hospital s single-source enterprise strategy, which is overwhelmingly driven by the established or new choice of the clinical system vendor. CFOs (80%) in a pre-purchase mode of RCM claim to be biased towards bolt-on functionalities that have a higher probability of delivering high results to hospital and its bottom line. 93% are demanding evidence of financial functionality that encompass population health, coding, analytics, forecasting, budgeting, and alternative payment reforms. Enterprise integration with an incumbent clinical system is no longer the biggest motivator when making an RCM vendor selection, except in hospitals under 100 beds, according to 77% of CFOs. Narrowing margins and escalating costs, drops in Medicare, Medicaid and commercial reimbursements are forcing executives to collaborate across agendas to increase efficiencies and automate to save the bottom line. Hospital budgets are already struggling with decreased reimbursements have the demand of purchasing or upgrading integrated RCM and clinical software. 10

11 OTHER KEY CFO FINDINGS Q % of hospital (under 200 beds) CFOs do not intend to let the facility s legacy clinical system have bearing on their RCM decision, compared to 97% of large hospital CFOs. 81% feel the pressure to make a RCM decision by calendar year end 2016, that have not already selected an RCM strategy for products or services. 93% in Q4 see the lack of a decision is actually a threat to their job stability. 49% feel they will lose their jobs in 2017 regardless of the RCM choices they made in 2015 or more recently. 80% of small and community hospitals anticipate declining-to-negative profitability in 2017 due to diminishing reimbursements, unrecovered collections, and underutilized or inefficient billing and records technology. 75% of CFOs fear that the ramifications of their outdated and/or auto-piloted revenue cycle management systems, particularly those not integrated to other systems will force the hospital to outsource the entire business office function, end-to-end, or purchase a new next generation RCM solution by year end % of small and community hospitals integrating recently acquired (independent) physician practices find the RCM systems in those medical offices obsolete or dysfunction for current patient financial processes with the hospital. In 2014, that figure was 94%. 77% of Hospital CFOs consider outsourcing to be the best stop gap measure until new RCM software is afforded and installed. More than 70% seek new outsourcing agreements extending at least months. 79% of Hospital CFOs of hospitals under 200 beds consider end-to-end RCM outsourcing to be the best solution until after value-based payment models are better established and coding challenges are worked through. 74% of Hospital CFOs in large hospitals and academic medical centers over 200 beds see outsourcing at least two revenue cycle management functions, up from 58% a year prior. 84% of small and community hospitals are considering using a Consultant to assist in integrations, vendor selections, outsourcing determinations, and total transformations or new RCM product implementations, up from 66% in However, 73% of hospital CFOs considering RCM consulting advice report delays and/or difficultly in securing RCM consulting engagements with the top rated firms based on current demand, down from 91% during the rush for consultants in Q % of CFOs contracting consultants in the RCM transformation process complain that many of the consultants assigned their organizations were entry level and/or inexperienced staff. 83% of hospitals under 200 beds are considering a combination of new software and outsourcing services to improve their RCM systems under ICD 10 and accountable care. 95% of hospitals with more than 200 beds anticipate supplementing their existing RCM software with outsourcing services In Q1 2017, as the ICD-10 repercussions begin to affect their cash flows and more value-based reimbursement opportunities are presented. 11

12 HOSPITALS CONFIRMING RCM SYSTEM REPLACEMENT ACTIVITIES (CHANGE WITHIN NEXT 24 MONTHS) SELECT 2 MOST RELEVANT IN ORDER OF PREFERENCE Primary Goals of Hospital acquiring new RCM Software and/or Outsourcing Services Strongly Prefer Strongly Prefer Strongly Prefer Strongly Prefer Upgrade RCM Software Solution only End-to-end and/or Bolt-on solutions 55% 35% 33% 25% Upgrade RCM/EHR Collectively 8% 10% 4% 6% Outsource RCM (Full Enterprise) 16% 46% 69% 20% Part RCM Software Upgrades/Replacements with Some Outsourced Functions/Services 80% 82% 80% 91% Seamless RCM/Clinical Information System 79% 40% 12% 11% Prefer One Vendor for RCM/CIS-HIS Solution 4% 1% 2% 5% Vetting a RCM solution is extremely complex as many hospitals have discovered that after purchasing a solution set, they are unable to do much of what was promised and even less has been delivered. The lagging legacy vendors are mainly built to compliance specifications and providers are finding these are completely unusable for a hospital with variable census and payer mix. NEW RCM SOFTWARE ACQUISITIONS (IMPLEMENTED IN LAST MONTHS) Situation/Insight After 6 months After 12 Months After 18 Months Still in New User Survival Mode 36% 10% 10% Cannot customize due to staffing issues/turnover 87% 14% 12% Will not maximize RCM software (ever) 66% 52% 14% Cannot integrate network practice technologies 62% 60% 46% Limited data building and underutilized features 90% 79% 76% Mastered basic and intermediate tasks so that return on investment is being realized Capabilities and expertise of system and staff have made tangible financial impacts 35% 50% 60% 15% 39% 52% 12

13 IMMEDIATE IMPROVEMENTS TO HOSPITAL REALIZED AFTER RCM IMPLEMENTATION & TRANSFORMATION INITATIVES Select Six or Less of the Top Improvements Noted after RCM Transformation Activities NEW RCM SOFTWARE IMPLEMENTED NEW RCM OUTSOURCING SERVICES Productivity & Re-balanced Workflows 80% 65% EHR Charge Sweeps & Reconciliation 95% 74% Accurate and Actionable Daily Reports 88% 77% Payment Resolution 89% 93% Filing Insurance Claims (Primary & Secondary) 89% 96% Resolve Rejections 71% 84% Post Payments 87% 97% Perform Collections 61% 96% Follow up on Appeals and Denials 73% 93% Perform Audits A/R & Charge Logs 91% 91% Review payer denials and rejections 52% 80% Improve Coding and Compliance 79% 89% Source: Black Book 13

14 RCM OUTSOURCING VENDOR SATISFACTION BY HOSPITAL (BED) SIZE Hospitals over 175 beds but less than 550 beds report highest satisfaction and ROI from legacy system RCM implementations within the past twelve months. Academic medical centers are the least satisfied with recent RCM software implementations. Complex system vendors, typically in use at large hospitals and academic medical centers over 400 beds, hospital systems, IDNs, CINs, chains, clinics and groups use more bolt-on RCM vendors with greatest satisfaction. End-to-end outsourcers nthrive, Conifer, and Optum360 ranked as the top three service vendors across all inpatient settings. INDUSTRY EVOLUTION TO END-TO-END RCM OUTSOURCING VENDORS TOP TEN OFFERINGS TO ALL HOSPITAL GROUPS/SYSTEMS/NETWORKS RESPONDING 2016 RCM OUTSOURCER GRADING VALUE-BASED REIMBURSEMENT TRANFORMATION CAPABILITIES Small & Rural Hospitals (100 Beds or Less) Community Hospitals ( Beds) Large Hospitals & Academic Medical Centers (200+ Beds) Hospital Systems & Proprietary Chains, IDNs and ACOs Optum A A A A nthrive MedAssets/Precyse A A A A Conifer Health A A A A Parallon Business B A B B Availity B A B A McKesson RelayHealth C A B A Change Healthcare B B C B Adreima C B C C Experian Passport C C C C The SSI Group C C C C KEY A = 90%+ SATISFACTION RATING B = 80%-90% SATISFACTION C = 70%-80% SATISFACTION SOURCE: BLACK BOOK Q

15 TOP 20 RCM OUTSOURCING VENDORS HOSPITAL CHAINS & SYSTEMS OUTSOURCING VENDORS: REVENUE CYCLE MANAGEMENT & ANALYTICS 2016 Rank by User Satisfaction/ Client Experience 1 OPTUM360 Hospital Revenue Cycle Management & Analytics Outsourcing Product RCM Vendor 2 NTHRIVE MEDASSETS 3 CONIFER HEALTH 4 PARALLON BUSINESS 5 AVAILITY 6 MCKESSON 7 EXPERIAN PASSPORT 8 GE HEALTHCARE 9 APEX 10 CHANGE HEALTHCARE 11 AVADYNE 12 ADREIMA 13 THE SSI GROUP 14 CONNANCE 15 GEBBS 16 MEDASSIST FIRSTSOURCE 17 SUTHERLAND 18 TRANSUNION 19 NAVIGANT CYMETRIX 20 XEROX Source: Black Book 15

16 User Reasons for Revenue Cycle Management highest vendor satisfaction rates 2016 Implementations Clients select top five that apply to their respective vendor performance and relationships ACO development & Value-Based-Payment Reform 95.6% Analytics and Business Decision Support 90.2% Seamless EHR Integration, Population Health Initiatives 83.5% Demonstrated cost savings & ROI for IDNs & CINs 83.3% Improved charge/reimbursement execution & coding 82.1% Continuous productivity improvements 17.20% Innovation in reimbursement capabilities 20.00% Clinician (physician and nursing) satisfaction 6.70% Ongoing flexibility to adapt 9.90% Customization, disparate financial systems issues resolved 13.00% Vendor Responsiveness to users 30.50% Source: Black Book 16

17 SURVEY PARTICIPATION: RCM This segment of the Black Book Revenue Cycle Management Software and Outsourcing survey for hospitals included insights from 1,750 users from 398 hospitals and healthcare delivery networks. Each survey pool was collected across three separate polls in March and September Respondent Title Respondents CEO or Corporate Officer 82 CFO or Finance Director/Manager 1,404 CIO or IT Director/Manager 395 Business Office Supervisor or Director 975 Business Office Staff (Representative for Management) 1,481 Physician 119 Nurse, Ancillary Management or Clinician 140 Other 215 TOTAL 4,811 Source: Black Book 17

18 2016 BLACK BOOK METHODOLOGY How the data sets are collected Black Book collects ballot results on 18 performance areas of operational excellence to rank vendors by electronic medical and health record product lines. The gathered data are subjected immediately to an internal and external audit to verify completeness and accuracy and to make sure the respondent is valid while ensuring that the anonymity of the client company is maintained. During the audit, each data set is reviewed by a Brown-Wilson executive and at least two other people. In this way, Black Book's clients are able to clearly see how a vendor is truly performing. The 18 criteria on operational excellence are subdivided by the client's industry, market size, geography and functions outsourced, and are reported accordingly. Situational and market studies are conducted on areas of high interest such as e-prescribing, Health information Exchange, Accountable Care organization, hospital software, outsourcing services providers, educational providers in e-health, benchmarkers and advisors. These specific survey areas range from four to 20 questions of criteria each. Understanding the statistical confidence of Black Book data Statistical confidence for each performance rating is based upon the number of organizations scoring the electronic medical and health records service. Black Book identifies data confidence by one of several means: o o o Top-10-ranked vendors must have a minimum of 10 unique clients represented. Broad categories require a minimum of 20 unique client ballots. Data that are asterisked (*) represent a sample size below required limits and are intended to be used for tracking purposes only, not ranking purposes. Performance data for an asterisked vendor's services can vary widely until a larger sample size is achieved. The margin of error can be very large and the reader is responsible for considering the possible current and future variation (margin of error) in the Black Book performance score reported. Vendors with more than 20 unique client votes are eligible for top 10 rankings and are assured to have highest confidence and lowest variation. Confidence increases as more organizations report on their vendor. Data reported in this form are shown with a 95% confidence level (within a margin of 0.25, 0.20 or 0.15, respectively). Raw numbers include the quantity of completed surveys and the number of unique organizations contributing the data for the survey pool of interest. 18

19 Who participates in the Black Book Ranking process? More than 541,000 hospital leaders and other users ranking from system executives, clinicians, IT specialists and front-line implementation veterans are invited to participate in the 2016 healthcare technology and services satisfaction surveys. Non-invitation receiving participants must complete a verifiable profile, utilize a valid corporate address and are then included as well. The Black Book survey web instrument is open to respondents and new participants periodically for several surveys at blackbookmarketresearch.com and Only one ballot per corporate address is permitted and changes of ballots during the open polling period require a formal request process to ensure integrity. Follow up RCM surveys were conducted from August 1 to September 15 to analyze the replacement market phenomenon within the RCM marketplace. Additionally, from April 15 to August 31 to collect data on Revenue Cycle Management solution satisfaction including Physician Practice Management applications, services and initiatives. Hospital Revenue Cycle Management outsourcing vendor rankings and results ,811 qualified users of systems with validated corporate/valid addresses ranked 128 RCM software solution, technology, outsourcing and SaaS suppliers offering individual or bundled arrangements as part of the Black Book annual survey, which was conducted via web survey instruments. Additionally 1,902 users answered questions about budgeting, vendor familiarity and vendor selection processes. The four most highly utilized systems of RCM solutions are included as subsets. 3,004 participants identified themselves as replacement market prospective RCM buyers. 1,546 Physician Practices, Groups and Clinics (staffers and clinicians) also submitted satisfaction ballots to rank and report client experience among practice management and revenue cycle management software and outsourcing services vendors. 398 inpatient hospitals in total participated in the 2016 RCM software vendor review process. 217 inpatient hospitals responded to outsourcing services and vendor analyses. 19

20 STOP LIGHT SCORING KEY Figure 1: Comprehensive Hospital Revenue Cycle Management& Analytics vendors are defined as being comprised of four surveyed functions BILLING, CHARGE CAPTURE, CODING CLAIMS MANAGEMENT REIMBURSEMENT, INSURANCE/PAYOR MANAGEMENT PAYMENT, RESOLUTION & COLLECTIONS Source: Black Book BLACK BOOK TOP HOSPITAL REVENUE CYCLE MANAGEMENT & ANALYTICS TECHNOLOGY VENDORS Published September

21 STOP LIGHT SCORING KEY Figure 2: Key to raw scores Deal breaking dissatisfaction Does not meet expectations Cannot recommend vendor Neutral Meets/does not meet expectations consistently Would not likely recommend vendor Satisfactory performance Meets expectations Recommends vendor Overwhelming satisfaction Exceeds expectations Highly recommended vendor Source: Black Book Market Research 21

22 STOP LIGHT SCORING KEY Figure 3: Color-coded stop light dashboard scoring key Green (Top 10%) scores better than 90% of RCM vendors. Green coded vendors have received constantly highest client satisfaction scores Clear (Top 33%) scores better than 67% of RCM vendors. Well-scored vendor which have middle of the pack results to 8.70 Yellow Scores better than half of RCM vendors. Cautionary performance scores, areas of improvement required to 7.32 Red Scores worse than 66% of RCM vendors. Poor performances reported potential cause for service and contractual cancellations. Less than 5.79 Source: Black Book Market Research 22

23 STOP LIGHT SCORING KEY Figure 4: Raw score compilation and scale of reference Black Book raw score scales 0 = Deal breaking dissatisfaction 10 = Exceeds all expectations Source: Black Book Market Research Individual vendors can be examined by specific indicators on each of the main functions of EHR PM/RCM as well as grouped and summarized subsets. Detail of each subset is contained so that each EHR PM/RCM vendor may be analyzed by function and end-to-end EHR PM/RCM services collectively. 23

24 OVERALL KPI LEADERS Figure 5: Scoring key OVERALL Q6 CRITERIA RCM VENDOR BILLING, CHARGE CAPTURE, CODING CLAIMS MANAGEMENT REIMBURSEMENT, INSURANCE/PAYOR MGMT PAYMENT, RESOLUTION & COLLECTIONS MEAN 5 1 HOSPITAL RCM OUTSOURCING FIRM Source: Black Book Market Research Overall rank this rank references the final position of all 18 criteria averaged by the mean score collectively. This vendor ranked fifth of the 20 competitors. Criteria rank refers to the number of the question or criteria surveyed. This is the sixth question of the 18 criteria of which this vendor ranked first of the 20 vendors analyzed positioned only on this particular criteria or question. Company name of the Hospital Revenue Cycle Management Technology Solutions vendor (sample name). Subsections each subset comprises one-fourth of the total RCM vendor mean at the end of this row, and includes all buyers and users who indicate that they contract each respective service subsection with the supplier, specific to their enterprise. Mean congruent with the criteria rank, the mean is a calculation of all four subsets of RCM functions surveyed. As a final ranking reference, it includes all vertical industries, market sizes and geographies. 24

25 OVERALL KEY PERFORMANCE INDICATOR LEADERS Outsourced hospital revenue cycle management & analytics SUMMARY OF CRITERIA OUTCOMES: RCM Table 1: Summary of criteria outcomes HOSPITAL SYSTEMS, CHAINS & CORPORATIONS RCM TECHNOLOGY OUTSOURCING VENDORS Total number one criteria ranks RCMO Technology Vendor Overall rank 10 OPTUM NTHRIVE MEDASSETS 2 3 CONIFER HEALTH 3 1 PARALLON BUSINESS 4 1 EXPERIAN PASSPORT 7 Source: Black Book Market Research BLACK BOOK TOP HOSPITAL REVENUE CYCLE MANAGEMENT & ANALYTICS TECHNOLOGY VENDORS Published September

26 TOP SCORE PER INDIVIDUAL CRITERIA: Hospital Chains, Systems, Corporations & Networks Revenue cycle management outsourcing vendors Top score per individual criteria RCM Table 2 : Top score per individual criteria Questions Criteria RCM Outsourcing Vendor Overall Rank 1 Strategic Alignments OPTUM Innovation, Risk Models CONIFER HEALTH 3 3 Training NTHRIVE MEDASSETS 2 4 Client relationships and cultural fit OPTUM Trust, Transparency, Ethics, Accountability NTHRIVE MEDASSETS 2 6 Breadth of offerings, client types, delivery excellence OPTUM Deployment and implementation EXPERIAN PASSPORT 7 8 Customization PARALLON BUSINESS 4 9 Integration and interfaces NTHRIVE MEDASSETS 2 10 Scalability, client adaptability, flexible pricing OPTUM Compensation and employee performance OPTUM Reliability OPTUM Brand image and marketing communications OPTUM Marginal value adds OPTUM Viability, Managerial Stability CONIFER HEALTH 3 16 Data security and backup services CONIFER HEALTH 3 17 Support and customer care OPTUM Best of breed technology and process improvement OPTUM360 1 Source: Black Book TM 26

27 PART TWO: ED OUTSOURED RCM VENDOR SATISFACTION & PERFORMANCE 2016 INDIVIDUAL KEY PERFORMANCE: OUTSOURCED REVENUE CYCLE MANAGEMENT & ANALYTICS SOLUTIONS HOSPITAL CHAINS, SYSTEMS, CORPORATIONS & NETWORKS 27

28 Individual Key Performance: Hospital Corporations, Chains, Systems & IDNs - Revenue cycle management Outsourcing Table 3 : INPATIENT HOSPITALS & AFFILIATED MEDICAL PRACTICES, Top Ranked Outsourcing Vendors raw scores 2016 Rank RCM Outsourcing Vendor Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12 Q13 Q14 Q15 Q16 Q17 Q18 Mean 1 OPTUM NTHRIVE MEDASSETS CONIFER HEALTH PARALLON BUSINESS AVAILITY MCKESSON EXPERIAN PASSPORT GE HEALTHCARE APEX CHANGE HEALTHCARE AVADYNE ADREIMA THE SSI GROUP CONNANCE GEBBS MEDASSIST FIRSTSOURCE SUTHERLAND TRANSUNION NAVIGANT CYMETRIX XEROX Source: Black Book Market Research BLACK BOOK TOP HOSPITAL OUTSOURCED REVENUE CYCLE MANAGEMENT & ANALYTICS TECHNOLOGY VENDORS Published September Black Book Market Research LLC. This report is a licensed product. Do not duplicate or distribute without permission 28

29 Individual Key Performance: Hospital Chains, Systems, Corporations & Networks - Revenue cycle management Outsourcing 1. Strategic Alignment of Vendor efforts, products and outcomes to Provider client organizational goals RCM Table 4: Organizational structure meets the needs of stakeholders or customers and stakeholder satisfaction is the most important priority. Hospital RCM client is likely to recommend the vendor to similar sized facilities. OVERALL Q1 CRITERIA RCM VENDOR BILLING, CHARGE CAPTURE, CODING CLAIMS MANAGEMENT REIMBURSEMENT, INSURANCE/ PAYOR MGMT PAYMENT, RESOLUTION & COLLECTIONS MEAN 1 1 OPTUM CONIFER HEALTH NTHRIVE MEDASSETS MCKESSON PARALLON BUSINESS AVAILITY APEX EXPERIAN PASSPORT AVADYNE CHANGE HEALTHCARE Source: Black Book Market Research BLACK BOOK TOP HOSPITAL OUTSOURCED REVENUE CYCLE MANAGEMENT & ANALYTICS TECHNOLOGY VENDORS Published September Black Book Market Research LLC. This report is a licensed product. Do not duplicate or distribute without permission 29

30 Individual Key Performance: Hospital Chains, Systems, Corporations & Networks - Revenue cycle management Outsourcing 2. Innovation RCM Table 5: Customers are also continuing to push the envelope for further enhancements to which the RCM vendor is responsive. RCM clients also believe that their vendors technology is helping them manage hospitals more effectively, generate accurate records and reimbursement billings and cut their overhead in ways that were difficult or impossible to accomplish before the outsourcing was implemented. Vendor is responsive to make client recommendations with cutting edge improvements specific to hospitals. OVERALL Q2 CRITERIA RCM VENDOR BILLING, CHARGE CAPTURE, CODING CLAIMS MANAGEMENT REIMBURSEMENT, INSURANCE/ PAYOR MGMT PAYMENT, RESOLUTION & COLLECTIONS MEAN 3 1 CONIFER HEALTH NTHRIVE MEDASSETS AVAILITY OPTUM CHANGE HEALTHCARE ADREIMA MCKESSON APEX EXPERIAN PASSPORT AVADYNE Source: Black Book Market Research BLACK BOOK TOP HOSPITAL OUTSOURCED REVENUE CYCLE MANAGEMENT & ANALYTICS TECHNOLOGY VENDORS Published September Black Book Market Research LLC. This report is a licensed product. Do not duplicate or distribute without permission 30

31 Individual Key Performance: Hospital Chains, Systems, Corporations & Networks - Revenue cycle management Outsourcing 3. Training RCM Table 6: Outsourcing vendor leadership provides significant and meaningful training opportunities for internal employees and client staff in RCM. Leadership strives to develop technology staff, RCM client service and customer servicing consultant employees, in particular. Training modules are effective and practical so that minimal post-implementation training is required on or off site. Regular updates are timely and require minimal additional training to implement. OVERALL Q3 CRITERIA RCM VENDOR BILLING, CHARGE CAPTURE, CODING CLAIMS MANAGEMENT REIMBURSEMENT, INSURANCE/ PAYOR MGMT PAYMENT, RESOLUTION & COLLECTIONS MEAN 2 1 NTHRIVE MEDASSETS OPTUM CONIFER HEALTH PARALLON BUSINESS EXPERIAN PASSPORT ADREIMA AVAILITY MCKESSON MEDASSIST FIRSTSOURCE APEX Source: Black* Book Market Research BLACK BOOK TOP HOSPITAL OUTSOURCED REVENUE CYCLE MANAGEMENT & ANALYTICS TECHNOLOGY VENDORS Published September Black Book Market Research LLC. This report is a licensed product. Do not duplicate or distribute without permission 31

32 Individual Key Performance: Hospital Chains, Systems, Corporations & Networks - Revenue cycle management Outsourcing 4. Client relationships and cultural fit RCM Table 7: RCM outsourcing vendor leadership honors customer relationships highly. The relationship with the vendor elevates the customer reputation. Improving hospital financial services and healthcare delivery efficiency and effectiveness is a priority of the supplier. Governance of engagement is neither complex for buyer nor does it require vendor management attention regularly. There is no regular transparency or quality issue. There are no culture clashes or misfits that threaten relationship s success or client s satisfaction. OVERALL Q4 CRITERIA RCM VENDOR BILLING, CHARGE CAPTURE, CODING CLAIMS MANAGEMENT REIMBURSEMENT, INSURANCE/ PAYOR MGMT PAYMENT, RESOLUTION & COLLECTIONS MEAN 1 1 OPTUM NTHRIVE MEDASSETS PARALLON BUSINESS CONIFER HEALTH AVADYNE EXPERIAN PASSPORT GE HEALTHCARE AVAILITY MCKESSON APEX Source: Black Book Market Research BLACK BOOK TOP HOSPITAL OUTSOURCED REVENUE CYCLE MANAGEMENT & ANALYTICS TECHNOLOGY VENDORS Published September Black Book Market Research LLC. This report is a licensed product. Do not duplicate or distribute without permission 32

33 Individual Key Performance: Hospital Chains, Systems, Corporations & Networks - Revenue cycle management Outsourcing 5. Trust, Accountability and Transparency RCM Table 8: Trust in enterprise reputation is important to RCM clients as well as prospects. Client possesses an understanding that its organization has the people, processes, and resources to effectively deliver the desired business and clinical results, based on its industry reputation and past performance. There are no disconnects between promises and delivery, and integration between hospital clinical and financial applications and revenue cycle management outsourcing is seamless. OVERALL Q5 CRITERIA RCM VENDOR BILLING, CHARGE CAPTURE, CODING CLAIMS MANAGEMENT REIMBURSEMENT, INSURANCE/ PAYOR MGMT PAYMENT, RESOLUTION & COLLECTIONS MEAN 2 1 NTHRIVE MEDASSETS OPTUM EXPERIAN PASSPORT APEX MCKESSON CHANGE HEALTHCARE CONIFER HEALTH GE HEALTHCARE AVAILITY PARALLON Source: Black Book Market Research BLACK BOOK TOP HOSPITAL OUTSOURCED REVENUE CYCLE MANAGEMENT & ANALYTICS TECHNOLOGY VENDORS Published September Black Book Market Research LLC. This report is a licensed product. Do not duplicate or distribute without permission 33

34 Individual Key Performance: Hospital Chains, Systems, Corporations & Networks - Revenue cycle management Outsourcing 6. Breadth of offerings, varied client settings, delivery excellence across all user types RCM Table 9: Hospital RCM vendor offers industry recognized horizontal functionality and vertical industry applications, and manage bundled services such as ACO, reimbursement reform and developing new e-health initiatives. Vendor routinely drives operational performance improvements and results in the areas they affect. Comprehensive offerings are constructed to meet the unique needs of the client s billing and collections initiatives. Breadth of vendor modules offers comprehensive system services and broad modules. OVERALL Q6 CRITERIA RCM VENDOR BILLING, CHARGE CAPTURE, CODING CLAIMS MANAGEMENT REIMBURSEMENT, INSURANCE/ PAYOR MGMT PAYMENT, RESOLUTION & COLLECTIONS MEAN 1 1 OPTUM PARALLON BUSINESS AVAILITY MCKESSON EXPERIAN PASSPORT ADREIMA CONIFER HEALTH NTHRIVE MEDASSETS GE HEALTHCARE CHANGE HEALTHCARE Source: Black Book Market Research BLACK BOOK TOP HOSPITAL OUTSOURCED REVENUE CYCLE MANAGEMENT & ANALYTICS TECHNOLOGY VENDORS Published September Black Book Market Research LLC. This report is a licensed product. Do not duplicate or distribute without permission 34

35 Individual Key Performance: Hospital Chains, Systems, Corporations & Networks - Revenue cycle management Outsourcing 7. Deployment and Revenue Cycle Management solution implementation & System-wide Standardization RCM Table 10: RCM outsourcing client deploys at a pace acceptable to the client. RCM solutions eliminate excessive supervision over vendor implementations. Vendor overcomes client implementation obstacles and challenges effectively. Technical, organizational and cultural implementation obstacles are handled professionally and punctually. Application implementation time meets standard expectations. Implementations are efficient and sensitive to users specific situations which may cause delays. OVERALL Q7 CRITERIA RCM VENDOR BILLING, CHARGE CAPTURE, CODING CLAIMS MANAGEMENT REIMBURSEMENT, INSURANCE/ PAYOR MGMT PAYMENT, RESOLUTION & COLLECTIONS MEAN 7 1 EXPERIAN PASSPORT OPTUM NTHRIVE MEDASSETS PARALLON BUSINESS APEX CONIFER HEALTH AVAILITY THE SSI GROUP MCKESSON GEBBS Source: Black Book Market Research BLACK BOOK TOP HOSPITAL OUTSOURCED REVENUE CYCLE MANAGEMENT & ANALYTICS TECHNOLOGY VENDORS Published September Black Book Market Research LLC. This report is a licensed product. Do not duplicate or distribute without permission 35

36 Individual Key Performance: Hospital Chains, Systems, Corporations & Networks - Revenue cycle management Outsourcing 8. Customization RCM Table 11: Hospital RCM outsourced services are customized to meet the unique needs of specific facility client purpose, processes and models. Little resistance is encountered when changing performance measurements as clients needs vary. Extraordinary efforts are made to adapt and convert client special needs into workable solutions with efficient cost and time considerations. All outsourced solutions allow for modifications that are not costly or complex. OVERALL Q8 CRITERIA RCM VENDOR BILLING, CHARGE CAPTURE, CODING CLAIMS MANAGEMENT REIMBURSEMENT, INSURANCE/ PAYOR MGMT PAYMENT, RESOLUTION & COLLECTIONS MEAN 4 1 PARALLON BUSINESS NTHRIVE MEDASSETS OPTUM CHANGE HEALTHCARE GE HEALTHCARE MCKESSON CONIFER HEALTH CONNANCE AVADYNE THE SSI GROUP Source: Black Book Market Research BLACK BOOK TOP HOSPITAL OUTSOURCED REVENUE CYCLE MANAGEMENT & ANALYTICS TECHNOLOGY VENDORS Published September Black Book Market Research LLC. This report is a licensed product. Do not duplicate or distribute without permission 36

37 Individual Key Performance: Hospital Chains, Systems, Corporations & Networks - Revenue cycle management Outsourcing 9. Integration and interfaces RCM Table 12: RCM vendor supports interfaces so information can be shared between necessary applications. Solutions are easily integrated to existing backend systems as needed and feasible for connectivity and interoperability purposes. Seamless interfaces to legacy applications and cloud systems alike are performed as required for optimal functioning. Human integration and interface activities are administered precisely. Systems communicate effectively among provider groups and ancillaries. True interoperability with other healthcare organizations is factored into implementation. OVERALL Q9 CRITERIA RCM VENDOR BILLING, CHARGE CAPTURE, CODING CLAIMS MANAGEMENT REIMBURSEMENT, INSURANCE/ PAYOR MGMT PAYMENT, RESOLUTION & COLLECTIONS MEAN 2 1 NTHRIVE MEDASSETS OPTUM CONIFER HEALTH PARALLON BUSINESS APEX EXPERIAN PASSPORT AVAILITY CONNANCE MEDASSIST FIRSTSOURCE ADREIMA Source: Black Book Market Research BLACK BOOK TOP HOSPITAL OUTSOURCED REVENUE CYCLE MANAGEMENT & ANALYTICS TECHNOLOGY VENDORS Published September Black Book Market Research LLC. This report is a licensed product. Do not duplicate or distribute without permission 37