Healthcare Info Competitive Analysis

Part
01
of two
Part
01

Healthcare Info Competitive Analysis

Availity is an internet-based information and technology services company that offers an exchange of information between health plans and providers while Definitive Healthcare is an information service company with a comprehensive data and intelligence portfolio on hospitals, physicians, health clinics, medical claims, and other healthcare providers.

Availity

Value Proposition

  • Availity's value proposition is the provision of real-time risk and quality information exchange between healthcare stakeholders and enhancing the provider data management process.
  • The company also offers patient financial solutions, developer healthcare APIs, vendor platform and supported systems solutions, and revenue cycle management.

Company Overview

  • Availity was founded in 2011 as a joint venture between Florida Blue and Humana to facilitate health plans and provider collaboration.
  • The CEO of Availity is Russ Thomas.
  • Availity's headquarters are in Jacksonville, Florida, the phone is 800-282-4548, and email is advancedclearinghouse@availity.com.
  • Availity has 850 employees.

Provider Solution

  • Availity solutions for providers include both free and premium information exchange services and API products for integration of HIPAA transactions among other features.
  • The company offers a free provider portal to connect with payers in real-time and file claims or check status, resolve overpayments, obtain remittances and manage attachments.
  • EDI clearinghouse is another solution offered to providers where they integrate HIPAA transactions to their Patient Management Software (PMS) or other custom software for increased efficiency.
  • The company also offers providers revenue cycle management solutions to assist in reducing claim denials, drive growth and profitability and optimize workflows through pre-service and post-service data quality and claim management.
  • Availity also offers providers access to real-time patient data such as dynamic estimates, addresses, and uninsured eligibility through their Patient Access Management suite for pre-service efficiency.

Competitive Advantage

  • Availity's competitive advantage is its large healthcare database and integration API solutions, and intellectual property. The company is connected to over 2.7k health plans and 1k vendors and supports over 800k daily logins, 1.6M daily provider connections, and over 200 Patient Management Software.
  • Availity holds 19 registered trademarks with the majority of them under scientific and technological service.

Revenue

  • Availity's most recent revenue is $180M

Number of Customers

  • Availity is used by 1,483 companies.
  • The company connects more than 20k payers nationwide.

Target Market

Availity target market includes health plans, providers, healthcare API developers, and vendors.

Definitive Healthcare

  • Definitive Healthcare is an information service company with a comprehensive data and intelligence portfolio on hospitals, physicians, health clinics, medical claims, and other healthcare providers.
  • Value Proposition
  • Definitive Healthcare's value proposition is found in its mission, which is the provision of comprehensive and accurate healthcare stakeholder's data and analytics to assist users to obtain an in-depth understanding of the market for sales and marketing and analysis of industry trends.

Company Overview

  • Definitive Healthcare was founded in 2011 by Jason Krantz, who is also its current CEO, to support client growth through access to accurate data and healthcare analytics.
  • The company's headquarters are in Framingham, Massachusetts, the company phone is (508) 720-4224 and email is sales@definitivehc.com.
  • Definitive Healthcare has 320 employees.

Provider Solution

  • Definitive Healthcare's platform offers four categories of solutions which include data products, go-to-market solutions, delivery and integration, and advanced analytics services.
  • Provider targeted solutions involve obtaining meaningful and comprehensive insights into the market and other providers, their quality performance, and health systems for developing effective growth strategies.
  • These solutions include competitive landscaping, understanding facility and clinician relationships, tracking patient journeys and referral patterns, and organizational bench marking.

Competitive Advantage

  • Definitive Healthcare's competitive advantage is its large data and intelligence portfolio on the various health stakeholders considered to be the most comprehensive and up-to-date in the healthcare information industry.
  • The company holds data of over 8,000 hospitals and Integrated Delivery Networks (IDNs), 800 Accountable Care Organizations (ACO) and Health Information Exchange (HIE), and 180k physician groups. It also holds data and information intelligence in over 7.2k ambulatory surgery centers, 15k Skilled Nursing Facilities, 1M physicians, and 750 Canadian hospitals.

Revenue

  • Definitive Healthcare's most recent annual revenue is $58.9M.

Number of Customers

  • Definitive Healthcare serves over 1,500 clients.

Target Market.

  • Definitive Healthcare targets various industries including Pharmaceuticals, Biotechnology, financial services, staffing & recruiting and facilities & construction.
  • Some career roles targeted by Definitive Healthcare are sales, data analysts, marketing, and staffing.
Part
02
of two
Part
02

Healthcare Info Competitive Analysis 2

    Quest Analytics LLC and LexisNexis Risk Solutions' healthcare data analytics division are two of the more than 150 companies in the healthcare data analytics market. The competitive landscape for these two companies includes company overviews, provider solutions, value propositions, competitive advantages of each company, annual revenues, number of customers, and the target market.

Quest Analytics

Company Overview
Provider Solution
  • Quest Analytics LLC helps health plans and healthcare organizations "to comply with federal and state regulations for network access, adequacy and accuracy" by reducing the risk of violating regulations for provider data accuracy.
Value Proposition
  • Quest Analytics LLC is the industry leader in innovations in network management.
  • The company is helping its partners "build more efficient and effective networks while creating better outcomes at a lower cost."
Competitive Advantage
  • Quest Analytics LLC is focused solely on healthcare, while LexisNexis has seven areas of focus. Thus, specialization could be Quest Analytics' competitive advantage.
Revenue
  • No verifiable information is available on the company's annual revenue for any year since its founding in 2003.
  • One source claims without any documentation that at one point the company's revenue was $2.3 million. No year was specified. Another source sets the company's revenue at $5 million.
Number of Customers
  • The company website claims "more than 400 health plans and healthcare organizations" as clients. This fact could not be independently verified.
Target Market

Lexis Nexis

Company Overview
  • "LexisNexis® Risk Solutions and its sister company LexisNexis® Legal & Professional are part of RELX Group, a global provider of information and analytics for professional and business customers across industries."
  • LexisNexis Risk Solutions works in seven areas: collections and recovery, financial services, government, healthcare, insurance, law enforcement and public safety, and corporations and nonprofits.
  • About 30,000 people work for LexisNexis in the US.
  • LexisNexis was founded in 1970. Its US headquarters are either in Atlanta, Georgia, New York City, or Ohio. There is no agreement from the sources as to the location of the headquarters. The website does not list an address.
Provider Solution
  • "LexisNexis® Risk Solutions provides customers with solutions and decision tools that combine public and industry specic content with advanced technology and analytics to assist them in evaluating and predicting risk and enhancing operational efciency. "
Value Proposition
  • The company characterizes its healthcare network software offerings as "unique data assets" including "social determinants of health, claims, and provider data to facilitate decision-making that impacts operational efficiency, compliance, growth strategies and patient engagement."
  • The company has developed products to service different segments of the healthcare analytics software market. It offers "solutions in the areas of payer, provider, life sciences, and pharmacy."
  • In the Provider segment, the company offers to provide "complete, current provider data including insights into relationships across IDNs, ACOs, payers and healthcare systems
  • In addition to offering specific products, the company claims to have "the industry’s most robust provider data repository built on data about millions of healthcare professionals, prescribers, healthcare organization affiliation and provider relationships. Our provider data repository also includes billions of medical claims, thousands of active health organizations and hundreds of integrated delivery networks."
Competitive Advantage
  • LexisNexis Risk Solutions is a global company. It is much larger than Quest Analytics LLC.
  • The company is ranked in the top 14 companies in the healthcare data analytics market by Frost & Sullivan. This ranking shows the size difference between Quest Analytics LLC and LexisNexis Risk Solutions. Quest Analytics LLC is not ranked as one of the top companies.
Revenue
  • According to Crunchbase.com, LexisNexis Risk Solutions' annual revenue is estimated at $2.1 billion.
Number of Customers
  • No information was available on the number or identify of LexisNexis Risk Solutions' healthcare industry customers.
Target market
Research Strategy
We were unable to find an estimate of the number of customers served by LexisNexis Risk Solutions healthcare data analytics division. To try to determine this figure, we consulted business data collection services such as Kiplinger, Bloomberg, Crunchbase.com, zoominfo.com, and owler.com. These services provide information such as addresses, key personnel names, stock prices, or acquisitions. These services did not include a statistic on a company's clients or customers. Next, we searched the LexisNexis company's website. We found macro-descriptions of the services and products available in the healthcare data analytics area, and of the data bases the company has developed. But there was no information there on the identity of their clients or the number of clients they serve. Third, we looked for healthcare data industry ranking articles and market assessments that might indicate the customer base. One article, prepared by Frost and Sullivan, was behind a paywall, but may have contained statistics.
Sources
Sources

From Part 02
Quotes
  • "More than 400 health plans and healthcare organizations trust Quest Analytics to reduce their risk for network adequacy and network accuracy."
  • " As the leading innovator in network management for 30 years, Quest Analytics is the first company with a comprehensive platform that integrates access, adequacy and accuracy. We’re helping our partners build more efficient and effective networks while creating better outcomes at a lower cost."
  • "We enable health plans to comply with federal and state regulations for network access, adequacy and accuracy ─ saving them millions of dollars in civil monetary penalties while improving member satisfaction. And we can do the same for you."
  • "We substantially reduce your regulatory risks for network adequacy because our measures of network performance are identical to those of our regulatory agency partners. "
  • "Quest Analytics can provide partners with a real-time lens into the performance of their networks — insights they can share with their organizations to improve efficiency and responsiveness. "
  • "We significantly reduce your regulatory risks for network accuracy with our BetterDoctor Exchange — the only continuously updated, primary sourced, and fully auditable national database of providers."
  • "Finally, we’ve created the Quest Network Alliance to connect the nation’s health plans, of which we already work with 400, with the nation’s providers. This addresses the problem of maintaining accurate provider data while enabling participating plans to share in the economies of scale we create from generating accurate data from providers that they share in common. "
  • " Trusted by more than 400 health plans and healthcare organizations, including: Humana, Western Health Advantage, Washington Healthplan Finder "
Quotes
  • " Revenue: 2.3M"
  • "Quest Analytics is an healthcare network management partner that enables health plans and healthcare organizations to build better networks that leverage bette"
  • "80 employee names and contact info are listed on Zoom's website, with dates of 2019 and 2020."
Quotes
  • "NEW YORK--(BUSINESS WIRE)--Vestar Capital Partners today announced that it has acquired Quest Analytics, L.L.C. Terms of the investment were not disclosed. "
  • "“Quest’s products and services are critical competitive tools for health plan networks in the current volatile and uncertain healthcare environment,” said Roger C. Holstein, Managing Director at Vestar Capital Partners. “As healthcare costs continue to rise, health plans are narrowing the size of provider networks in order to keep premiums affordable. Now more than ever, health plans look to Quest to help them design, contract, and monitor the access, adequacy, and accuracy of their networks.” "
Quotes
  • " By Lily Lieberman – Staff Writer, Kansas City Business Journal Nov 15, 2019, 3:48pm EST With offices in three other cities — Appleton, Wisc.; San Francisco and and San Diego — and more than 140 employees, Quest Analytics co-founder John Weis said the company chose Overland Park as its new headquarters because of its central location, close proximity to national and local customers and the city's tech talent."
Quotes
  • "Quest Analytics, L.L.C. designs and develops health care software. The Company provides cloud and software services that offers access, quality, adequacy, disruption analysis, geocoder, and automation. Quest Analytics serves customers in the United States."
Quotes
  • "Private, for profit company. Founded in 2003."
  • "At Quest Analytics, their mission is to provide healthcare network analysis and reporting solutions that meet the ever-changing demands of the industry. As the industry-leader and established standard for network access and adequacy analysis, they offer a full range of software solutions, cloud services, consulting and support services to help you meet your network analysis needs."
Quotes
  • "Weis, whose company helps hundreds of Medicare Advantage plans with their provider networks, said plans were expecting to start seeing fines for errors in their directories. "
Quotes
  • "There were 5,954 insurance companies in 2017 in the U.S. (including territories). According to the National Association of Insurance Commissioners those were comprised of the following: P/C (2,509); life/annuities (852); health (907); fraternal (82); title (58); risk retention groups (240) and other companies (1,306)."
Quotes
  • "1. There are 5,564 registered hospitals in the U.S., according to the American Hospital Association. This statistic includes federal hospitals, long-term care hospitals, psychiatric hospitals, institutions for the mentally disabled and alcohol and other chemical dependency rehabilitation hospitals. 2. Of these, 4,862 are considered community hospitals. Community hospitals represent about 85 percent of all hospitals in the U.S. There are 2,845 nonprofit community hospitals and 1,034 for-profit community hospitals. Additionally, 983 are owned by state or local (county, hospital district) government entities."
Quotes
  • " Government Health Programs Federal Employees Health Benefits Program Indian Health Service Medicaid / State Health Insurance Assistance Program (SHIP) Medicare Prescription Assistance (SPAP) Military Health System / TRICARE State Children's Health Insurance Program (CHIP) Program of All-Inclusive Care for the Elderly (PACE) Veterans Health Administration"
  • "Private Health Coverage Consumer-driven healthcare Flexible spending account (FSA) Health Reimbursement Account Health savings account (HSA) High-deductible health plan (HDHP) Medical savings account (MSA) Private Fee-For-Service (PFFS) Managed care (CCP) Exclusive provider organization (EPO) Health maintenance organization (HMO) Preferred provider organization (PPO) "
Quotes
  • "LexisNexis® Risk Solutions provides customers with solutions and decision tools that combine public and industry specific content with advanced technology and analytics to assist them in evaluating and predicting risk and enhancing operational efficiency. "
  • "We use the power of data and advanced analytics to help our customers make better, timelier decisions. Our innovative solutions enable organizations to manage risks like identity theft, fraud, money laundering and terrorism, and prevent financial crimes, and insurance and government benefit scams. We help those without traditional credit histories obtain access to funds, assist agencies to find uncollected revenue, and research ways to improve business outcomes for healthcare companies. We also work with law enforcement to solve crimes. "
  • "LexisNexis® Risk Solutions and its sister company LexisNexis® Legal & Professional are part of RELX Group, a global provider of information and analytics for professional and business customers across industries. The group serves customers in more than 180 countries and has offices in about 40 countries. It employs approximately 30,000 people of whom half are in North America. "
  • "LexisNexis works in seven areas: collections and recovery, financial services, government, healthcare, insurance, law enforcement and public safety, and corporations and nonprofits."
  • "As a pioneer in advanced analytics architecture, LexisNexis Risk Solutions leverages unique data assets including social determinants of health, claims, and provider data to facilitate decision making that impacts operational efficiency, compliance, growth strategies and patient engagement."
  • "L-N offers solutions in the areas of payer, provider, life sciences, and pharmacy."
  • "Provider: Access complete, current provider data including insights into relationships across IDNs, ACOs, payers and healthcare systems. LexisNexis offers the industry’s most robust provider data repository built on data about millions of healthcare professionals, prescribers, healthcare organization affiliation and provider relationships. Our provider data repository also includes billions of medical claims, thousands of active health organizations and hundreds of integrated delivery networks. Four products are available to help with provider data issues."
Quotes
  • "For the Frost Radar in the U.S. Healthcare Data Analytics Market report, Frost & Sullivan analyzed several health IT vendors within the data analytics space. While more than 150 companies offer analytics solutions within the healthcare marketplace, Frost & Sullivan's report includes vendors leading in the growth and innovation indexes."
  • "· Optum · Health Catalyst · Athenahealth · Salesforce · Allscripts · Inovalon · Cotiviti · SAP · Alteryx · Cerner · Lexis Nexis · IBM Watson Health · Qilk · Dimensional Insight"
Quotes
  • "Founded 1970 Headquarters Helmsley Building, New York City[1] United States Products Case law, articles, publications, news, court documents, lawyer marketing, law practice management tools, media monitoring tools, supply management tools, sales intelligence solutions, and market intelligence tools Parent RELX Group"
Quotes
  • "Headquarters: 9443 Springboro Pike, Miamisburg, Ohio, 45342, United States View Map Phone Phone: (937) 865-6800 Website Website: www.lexisnexis.com Employees Employees: 10,000 Description LexisNexis (www.lexisnexis.com) is a leading global provider of content-enabled workflow solutions designed specifically for professionals in the legal, risk ma... Read More"
Quotes
  • "Has $2.1 billion in estimated revenue annually"
  • "Headquarters Regions Greater Atlanta Area, East Coast, Southern US"
  • ""