Integrated Clinical and Claims Data: The Recipe for Healthcare Payer Analytics Success Finally Becoming a Reality According to Latest Chilmark Report

Leading analytics vendors’ capabilities expand the value of healthcare provider data and reach of applications to address quality, costs of care, and enterprise performance

Chilmark Research’s inaugural Healthcare Payer Analytics Market Trends Report confirms that the future of payer analytics is combined and aggregated clinical and claims datasets. While there is still much to be done to realize this goal fully, it is finally becoming more of a reality than ever before.  Analytics strategies originally developed for value-based care (VBC) are increasingly being applied to manage quality and costs across broader networks and populations. Within the next 3-5 years, the quality and thoroughness of comprehensive, real-time views of patients and cohorts will become the major differentiator of analytics tools.

For now, cost, quality, and utilization reporting remain the common thread among organizations using analytics tools, looking to achieve immediate goals like improving HEDIS measures and HCC scores, finding fraud, waste and abuse, and controlling total cost of care and identifying cost drivers. Payers are also turning to advanced analytics to predict a range of outcomes, costs and events. Over time, the market will need better tools and automation around data ingestion and aggregation than currently exists to continue reducing high-cost, low-quality care.

However, capitalizing on the value these tools provide remains a challenge. Payers find that current analytics tools are excellent at identifying areas for improvement but need engaged clinicians and members to take appropriate action. The offerings also need to do more to offer non-analysts the actionable insights they need to make measurable changes on their own.

According to Brian Murphy, Director of Research and lead report author, “Healthcare payers use these tools to understand what needs to be done but continue to experiment with different ways to enlist support among their networks, clinicians, and members. The problem of ‘actionability’ is more complex than simply presenting data to a user, and translating any payer-derived insights to providers is both a technological and organizational challenge.”

This comprehensive report provides an overview of the payer analytics and reporting market and evaluates offerings from 18 leading vendors, classified under three categories based on data focus: claims analytics, clinical analytics, and technology-enabled services vendors. Each profile includes an assessment of the vendor’s strengths and challenges, plus detailed descriptions and evaluations of both the product capabilities and market execution across 21 categories.

Commercial and government payers along with providers with health plans or value-based contracts looking to use more diverse data to manage costs and quality will benefit from the report’s overview of payer-specific use cases and extensive product evaluations and rankings. Self-insured employers, pharmacy benefit managers (PBMs), and other organizations managing total cost of care will find the market overview and evaluations of products specific to them particularly useful. Current and prospective solution providers of payer analytics solutions will also find this report’s descriptions of market trends and the competitive landscape valuable for mapping their own product strategy. Consultants, government officials, and other stakeholders will also find the report useful in assisting others with their healthcare analytics strategies and technology selection.

This report is available to select subscribers of the Chilmark Advisory Service or can be purchased separately. To read more, download a preview or register for the accompanying webinar on December 17, 2019, please view the report page. Direct inquiries for purchase should be addressed to John Moore III at

Vendors Profiled:, CareEvolution, Cerner Corporation, Certilytics, Change Healthcare, Clarify Health Solutions, Cotiviti, Health Catalyst, HealthEC, IBM Watson Health, MedeAnalytics, Medecision, Milliman, Optum, Philips, SCIO-EXL, SPH Analytics, ZeOmega