Latest news with #HealthcareAnalytics
Associated Press
3 days ago
- Business
- Associated Press
Black Book Research Names 2025's Top Vendors in Risk Adjustment & Coding Optimization for Health Plans and Payers
Advanced Analytics, AI, and Automation Become Essential as Payers Face Increased Scrutiny on Risk Adjustment Accuracy and Financial Performance NEW YORK CITY, NY / ACCESS Newswire / June 1, 2025 / As healthcare payers face intensified regulatory oversight, rising healthcare costs, and the evolving complexities of risk adjustment, Black Book Research today announced its 2025 rankings of the leading vendors in Risk Adjustment & Coding Optimization software. These solutions have become essential for payers seeking accurate, compliant, and financially optimized coding practices across Medicare Advantage, Medicaid managed care, ACA marketplace plans, and commercial insurers. According to Black Book's latest payer survey conducted between Q4 2024 and Q1 2025, with responses from 1,108 senior payer executives, finance officers, and risk adjustment leaders, 92% indicated that advanced analytics and artificial intelligence (AI) tools are now critical for accurate risk scoring, improved coding efficiency, and maintaining regulatory compliance. 'Health plans are urgently investing in technology solutions that provide precise, predictive, and fully compliant risk adjustment and coding practices,' said Doug Brown, President of Black Book Research. 'Optimized coding not only ensures regulatory compliance but significantly impacts financial stability, resource allocation, and member care quality.' Scope and Opportunity in Risk Adjustment & Coding Optimization Software The survey highlights a growing emphasis on several core areas where payer software solutions can dramatically enhance performance: Accurate Risk Scoring: 94% of respondents highlighted accuracy in HCC (Hierarchical Condition Categories) and RAF (Risk Adjustment Factor) scoring as their highest priority. Regulatory Compliance: 89% emphasized the importance of software capable of continuous compliance monitoring, automated audits, and coding validation. Predictive Analytics: 87% of payers prioritize advanced analytics solutions that anticipate risk and allow proactive management of populations. Automated Coding Processes: 70% noted the necessity for automation to reduce manual errors, streamline workflows, and accelerate coding accuracy. Interoperability and Data Integration: 66% reported interoperability as essential, ensuring seamless data flow among providers, payers, and regulatory bodies. Top 10 Vendors in Risk Adjustment & Coding Optimization (Ranked by Client Satisfaction and Performance) Edifecs - Distinguished for its robust interoperability solutions and real-time risk adjustment analytics that streamline payer workflows and ensure regulatory accuracy. Apixio - Recognized for its AI-powered risk adjustment analytics, utilizing natural language processing (NLP) to dramatically improve coding accuracy and risk stratification. SCIO Health Analytics (EXL) - Highly rated for predictive modeling and comprehensive analytics tools that significantly enhance coding accuracy, financial forecasting, and compliance management. Advantasure - Praised for its integrated risk adjustment platform, offering real-time analytics, automated chart reviews, and predictive risk identification. Change Healthcare - Valued for sophisticated coding optimization and analytics capabilities, significantly reducing audit risks and improving revenue accuracy. Innovaccer - Noted for advanced analytics and integrated workflows that seamlessly connect payer data streams, optimizing risk management strategies. Inovalon - Applauded for scalable analytics platforms and comprehensive interoperability, enhancing accuracy in risk scoring and regulatory compliance. Cotiviti - Recognized for its deep analytics and precise data validation, enabling payers to accurately capture risk and streamline coding compliance. Optum - Acknowledged for robust AI-driven risk adjustment and coding tools that integrate seamlessly across payer systems, delivering accuracy and compliance. Talix - Renowned for its innovative NLP-driven risk adjustment solutions that ensure precise coding, reducing compliance risk and maximizing revenue integrity. 'Risk adjustment and coding optimization software has become a strategic imperative for payers aiming to thrive in today's regulatory and competitive healthcare environment,' added Brown. 'Leveraging these technologies positions payers not only to achieve compliance but to realize substantial improvements in financial outcomes, operational efficiency, and member health management.' About Black Book Research Black Book Research provides unbiased, crowd-sourced insights into healthcare technology, services, and outsourcing. Since 2004, Black Book has surveyed over 1 million healthcare technology users and buyers, maintaining strict independence without vendor funding, advisory subscriptions, or performance improvement arrangements. To license the full complete 2025 Risk Adjustment & Coding Optimization report and detailed vendor performance metrics, visit: Media Inquiries: Email: [email protected] Contact Information Press Office [email protected] 8008637590 SOURCE: Black Book Research press release
Yahoo
4 days ago
- Business
- Yahoo
Black Book Research Names 2025's Top Vendors in Risk Adjustment & Coding Optimization for Health Plans and Payers
Advanced Analytics, AI, and Automation Become Essential as Payers Face Increased Scrutiny on Risk Adjustment Accuracy and Financial Performance NEW YORK CITY, NY / / June 1, 2025 / As healthcare payers face intensified regulatory oversight, rising healthcare costs, and the evolving complexities of risk adjustment, Black Book Research today announced its 2025 rankings of the leading vendors in Risk Adjustment & Coding Optimization software. These solutions have become essential for payers seeking accurate, compliant, and financially optimized coding practices across Medicare Advantage, Medicaid managed care, ACA marketplace plans, and commercial insurers. According to Black Book's latest payer survey conducted between Q4 2024 and Q1 2025, with responses from 1,108 senior payer executives, finance officers, and risk adjustment leaders, 92% indicated that advanced analytics and artificial intelligence (AI) tools are now critical for accurate risk scoring, improved coding efficiency, and maintaining regulatory compliance. "Health plans are urgently investing in technology solutions that provide precise, predictive, and fully compliant risk adjustment and coding practices," said Doug Brown, President of Black Book Research. "Optimized coding not only ensures regulatory compliance but significantly impacts financial stability, resource allocation, and member care quality." Scope and Opportunity in Risk Adjustment & Coding Optimization Software The survey highlights a growing emphasis on several core areas where payer software solutions can dramatically enhance performance: Accurate Risk Scoring: 94% of respondents highlighted accuracy in HCC (Hierarchical Condition Categories) and RAF (Risk Adjustment Factor) scoring as their highest priority. Regulatory Compliance: 89% emphasized the importance of software capable of continuous compliance monitoring, automated audits, and coding validation. Predictive Analytics: 87% of payers prioritize advanced analytics solutions that anticipate risk and allow proactive management of populations. Automated Coding Processes: 70% noted the necessity for automation to reduce manual errors, streamline workflows, and accelerate coding accuracy. Interoperability and Data Integration: 66% reported interoperability as essential, ensuring seamless data flow among providers, payers, and regulatory bodies. Top 10 Vendors in Risk Adjustment & Coding Optimization (Ranked by Client Satisfaction and Performance) Edifecs - Distinguished for its robust interoperability solutions and real-time risk adjustment analytics that streamline payer workflows and ensure regulatory accuracy. Apixio - Recognized for its AI-powered risk adjustment analytics, utilizing natural language processing (NLP) to dramatically improve coding accuracy and risk stratification. SCIO Health Analytics (EXL) - Highly rated for predictive modeling and comprehensive analytics tools that significantly enhance coding accuracy, financial forecasting, and compliance management. Advantasure - Praised for its integrated risk adjustment platform, offering real-time analytics, automated chart reviews, and predictive risk identification. Change Healthcare - Valued for sophisticated coding optimization and analytics capabilities, significantly reducing audit risks and improving revenue accuracy. Innovaccer - Noted for advanced analytics and integrated workflows that seamlessly connect payer data streams, optimizing risk management strategies. Inovalon - Applauded for scalable analytics platforms and comprehensive interoperability, enhancing accuracy in risk scoring and regulatory compliance. Cotiviti - Recognized for its deep analytics and precise data validation, enabling payers to accurately capture risk and streamline coding compliance. Optum - Acknowledged for robust AI-driven risk adjustment and coding tools that integrate seamlessly across payer systems, delivering accuracy and compliance. Talix - Renowned for its innovative NLP-driven risk adjustment solutions that ensure precise coding, reducing compliance risk and maximizing revenue integrity. "Risk adjustment and coding optimization software has become a strategic imperative for payers aiming to thrive in today's regulatory and competitive healthcare environment," added Brown. "Leveraging these technologies positions payers not only to achieve compliance but to realize substantial improvements in financial outcomes, operational efficiency, and member health management." About Black Book Research Black Book Research provides unbiased, crowd-sourced insights into healthcare technology, services, and outsourcing. Since 2004, Black Book has surveyed over 1 million healthcare technology users and buyers, maintaining strict independence without vendor funding, advisory subscriptions, or performance improvement arrangements. To license the full complete 2025 Risk Adjustment & Coding Optimization report and detailed vendor performance metrics, visit: Media Inquiries: Email: research@ Contact Information Press Office research@ SOURCE: Black Book Research View the original press release on ACCESS Newswire Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Yahoo
22-05-2025
- Health
- Yahoo
Predictive Disease Analytics Market Trends Analysis Report 2025-2030: AI and Analytics Tools Gain Traction as Healthcare Systems Seek Cost Efficiency and Better Outcomes
Predictive Disease Analytics Market Dublin, May 22, 2025 (GLOBE NEWSWIRE) -- The "Predictive Disease Analytics Market Size, Share & Trends Analysis Report by Component (Hardware, Software & Services), Deployment (On-premise, Cloud-based), End Use, Region, with Growth Forecasts, 2025-2030" report has been added to Predictive Disease Analytics Market was valued at USD 3.0 Billion in 2024, and is projected to reach USD 10.2 Billion by 2030, rising at a CAGR of 22.70% Predictive disease analytics refers to software solutions used by healthcare organizations, hospitals, and physicians to analyze and process patient data in order to provide data-driven, high-quality care, precise diagnostics, and individualized treatments. Predictive analytics is an advanced method to enhance patient outcomes in healthcare. Additionally, predictive analytics solutions are used by healthcare providers to comprehend disease prevalence, disease management, risk management & trajectories, and to provide suitable medical care to patients for optimal outcomes. Healthcare providers use it to evaluate the risk rate to an individual's health as well as predict future outcomes in preparation. Its use at various levels to avoid unnecessary expenditure had also increased the utilization of this technology, which is anticipated to continue throughout the forecast period. As a result, the global predictive disease analytics market is expected to analytics has played a significant part in combating COVID-19 problems, decreasing the incidence of poor outcomes for patients, and addressing resource management during the crisis. The massive amount of patient data produced during the outbreak not only provided analytics firms and the healthcare sector with data to properly analyze disease spread, but it also aided in resource allocation. Several institutions, including hospitals, was using predictive analytics to determine the probability of a patient developing severe symptoms, the trajectory of their infection/disease, and several other parameters. For instance, in 2020, researchers at the Cleveland Clinic in the U. S. created an automated analytics model that predicted an individual's chance of testing positive. Hence, propelling the market global market is expanding rapidly as a result of the increasing burden of chronic diseases, the emergence of personalized and evidence-based medicine, the growing need for increased efficiency in the healthcare sector, and the growing demand to reduce healthcare costs by eliminating unnecessary costs. As per the center for disease control, six out of every ten Americans have at least one chronic illness, such as heart disease or stroke, cancer, or diabetes. Hence, it will increase the product demand and further boost the market important reason driving market growth is the use of evidence-based medicine to provide the right kind of treatment to the right patient. The utilization of Electronic Health Records (EHRs) for patient records has increased in recent years, with adoption of EHRs in the case of office-based doctors increasing from 42% in 2008 to nearly 88% in 2021 in the U. S. Healthcare predictive analytics makes use of EHRs to recommend the best course of action in the event of a medical treatment or medication. This not only greatly reduces patient costs but also leads to improved outcomes. The adoption of electronic health systems, analytics tools, and artificial intelligence (AI) are expected to drive market development. The expense of healthcare has risen over the years owing to the increasing burden of chronic diseases on a global companies in the predictive disease analytics market are continuously expanding their product and services portfolio to accelerate the development of the product. For instance, in June 2022, Engagys LLC, a Health Consultant Company, announced the debut of a new affordable subscription service for healthcare systems, health plans, & healthcare technology leaders. Executive Advisory Services is intended to provide healthcare customer engagement practitioners with practical and actionable guidance, insights, and best practices that they can put to use immediately. This is expected to strengthen the company's position in predictive analytics solution and further boost the market Disease Analytics Market Report Highlights Cloud-based solutions are anticipated to have the highest CAGR during the forecast period. The ease of storage, inexpensive capital requirements, increased flexibility, and efficiency are attributed to its development. On the basis of end user, payer segment dominated the market in such as insurance firms, health plan sponsors, as well as other third-party payers, are among the primary beneficiaries of predictive analytics in healthcare settings. Thus, boosting the segment growth. Due to the rising prevalence of chronic diseases, greater awareness of preventive health and rising percentage of geriatric population in North America, the region had the largest market share. Why Should You Buy This Report? Comprehensive Market Analysis: Gain detailed insights into the market across major regions and segments. Competitive Landscape: Explore the market presence of key players. Future Trends: Discover the pivotal trends and drivers shaping the future of the market. Actionable Recommendations: Utilize insights to uncover new revenue streams and guide strategic business decisions. Key Attributes: Report Attribute Details No. of Pages 80 Forecast Period 2024 - 2030 Estimated Market Value (USD) in 2024 $3 Billion Forecasted Market Value (USD) by 2030 $10.2 Billion Compound Annual Growth Rate 22.7% Regions Covered Global Predictive Disease Analytics Market Variables, Trends & Scope Market Lineage Outlook Parent market outlook Related/ancillary market outlook Market Driver Analysis Rise in government initiatives and an increasing amount of money being invested in the healthcare industry Technological advancements in AI and machine learning Increasing prevalence of chronic diseases Growing shift towards personalized medicine Market Restraint Analysis Growing data privacy concerns Lack of skilled professionals High implementation cost Companies Featured Oracle Cerner Corporation IBM SAS Allscripts Healthcare Solutions Inc. MedeAnalytics, Inc. Health Catalyst. Apixio Inc GE Healthcare (a division of General Electric Company) Siemens Healthineers For more information about this report visit About is the world's leading source for international market research reports and market data. We provide you with the latest data on international and regional markets, key industries, the top companies, new products and the latest trends. Attachment Predictive Disease Analytics Market CONTACT: CONTACT: Laura Wood,Senior Press Manager press@ For E.S.T Office Hours Call 1-917-300-0470 For U.S./ CAN Toll Free Call 1-800-526-8630 For GMT Office Hours Call +353-1-416-8900
