Everest Group PEAK Matrix® for Healthcare Cloud-based Core Administration
Platforms Provider 2023
Focus on TriZetto (Cognizant)March 2023

Copyright © 2023 Everest Global, Inc.
This document has been licensed to TriZetto (Cognizant)Everest Group PEAK Matrix® for Healthcare Cloud-based Core Administration Platforms Provider 2023

Introduction

Core administration platforms form the backbone of health plans and payer organizations, enabling them to efficiently perform core operational and administrative functions such as
benefits administration, claims processing, member enrollment, claims payment and adjustments, and product management for benefits and product lines. The legacy Core Administrative
Processing Solutions (CAPS) fall short when it comes to keeping up with the rapidly evolving delivery and implementation options and IT systems integration. While these systems havegenerally been stable and stood the test of time for decades, they are often highly customized to the client’s requirements and are hosted on-premise. This translates into high inertia whenit comes to phasing these legacy solutions with modern cloud-based core administration solutions as the associated risks and efforts required are high.
However, triggered by the rapidly evolving industry compliance and regulatory requirements, challenges and opportunities for payment reform, and the emergence of value-based care, theindustry is on the lookout for new vendors to partner up with.
In this research, we present an assessment of 14 healthcare core administration platform providers featured on the Healthcare Cloud-based Core Administration Platforms PEAK Matrix®
Assessment 2023. The assessment is based on Everest Group’s annual RFI process for the calendar year 2022, interactions with leading healthcare core administrative processing
platform providers, client reference checks, and ongoing analysis of the US healthcare CAPS market.
The full report includes the profiles of the following 14 leading healthcare core administration platform providers featured on the Healthcare Cloud-based Core Administration
Platforms PEAK Matrix:Leaders: HealthEdge and TriZetto (Cognizant)

Major Contenders: Conduent, Evolent, Invidasys, Javelina (Mphasis), Oracle, PEGA, Plexis, RAM Technologies, and SS&C Health

Aspirants: Advantasure, HealthAxis, and NASCO

Scope of this report
Geography
US

Proprietary & Confidential. © 2023, Everest Global, Inc. | licensed to TriZetto (Cognizant)Providers
Healthcare (payers andproviders)Services
Healthcare coreadministration platforms

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Everest Group PEAK Matrix® for Healthcare Cloud-based Core Administration Platforms Provider 2023

Healthcare core administration platforms PEAK Matrix® characteristics

Leaders:
HealthEdge and TriZetto (Cognizant) Leaders are making strategic investments to continuously enhance their healthcare core administration platform through internal IP / tools development, M&A, partnerships, etc. (e.g.,
TriZetto (Cognizant)’s acquisition of 10th Magnitude to enhance its cloud capabilities, and HealthEdge’s investment in developing its deep-technology IP across cutting-edge
technologies such as intelligent automation)

Leaders have established themselves as front runners in offering healthcare core administration platforms for healthcare enterprises on the back of their strong vertical and technicalcapabilities. They also provide strong support services to assist enterprises on implementing and deploying the platform and addressing any client grievances or issues
Leaders’ healthcare core administration platform offerings provide comprehensive coverage across healthcare core administration value chain areas – product development, policy
servicing, provider and contract management, and claims administration. They also provide an extensive coverage beyond the core value chain areas such as care management,
payment integrity, and provider credentialing across all the lines of business (such as Medicaid, Medicare, and Commercial)

Major Contenders:
Conduent, Evolent, HealthAxis, Invidasys, Javelina (Mphasis), Oracle, PEGA, Plexis, RAM Technologies and SS&C Health The market portfolio of Major Contenders is not as comprehensive as compared to Leaders in platform coverage and line of business presence

Major Contenders are trying to bridge the gap between themselves and the Leaders by leveraging new-generation technologies to build solutions around them and engaging in strategic
partnership constructs to increase their market impact and clientele

Aspirants:
Advantasure and NASCO
 Aspirants should look to enhance their product offerings around areas such as product development and provider and contract management to provide an end-to-end core administration
platform for healthcare clients

Aspirants should look to augment their technological capabilities that are being leveraged via platforms such as intelligent automation and advanced analytics and strengthen theirpartnership ecosystem to increase their platform capabilities and value proposition
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Everest Group PEAK Matrix® for Healthcare Cloud-based Core Administration Platforms Provider 2023

Everest Group PEAK Matrix®
Healthcare Cloud-based Core Administration Platforms PEAK Matrix® Assessment 2023 |TriZetto (Cognizant) positioned as Leader
Everest Group Healthcare Cloud-based Core Administration Platforms PEAK Matrix® Assessment 20231
High

Leaders

Leaders
Market impact
Measures impact created in the market

TriZetto (Cognizant)HealthEdge
OraclePlexisSS&C HealthInvidasys
Advantasure
NASCO
HealthAxis

Javelina (Mphasis)

PEGA

Evolent

Conduent
RAM Technologies

Aspirants
Low

Source:Aspirants

Major Contenders

Low

1

Major Contenders

Vision & capability
Measures ability to deliver products successfully

High

Assessments for Advantasure, Conduent, Evolent, HealthAxis, HealthEdge, NASCO, PEGA, Oracle, RAM Technologies and SS&C Health excludes platform vendors inputs and are based on Everest Group’s proprietary Transaction Intelligence (TI)
database, provider public disclosures, and Everest Group’s interactions with insurance buyers
Everest Group (2023)
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Everest Group PEAK Matrix® for Healthcare Cloud-based Core Administration Platforms Provider 2023

TriZetto (Cognizant) | healthcare cloud-based core administration platforms profile (page 1 of 4)
Overview
Company mission/vision statement
Cognizant’s mission is to engineer products to enable connections and collaborative insights to improvehealthcare outcomes. For its core administrative solution, its vision is to strengthen its clients’ market position
for all lines of business by providing core administrative capabilities, fueled by innovative technologies insoftware design and architecture. Cognizant enables client entry into new markets and leverages rich data
sources for providing insights and improving outcomes.
Overview of the client baseCognizant serves more than 225 health plans across multiple lines of business and includes large national
payers, regional multi-state players, single-state, and specialty payers. Clients also include TPAs, PBMs, aleading healthcare company, a leading US-based retail pharmacy and PBM, a US-based healthcare system, amajor healthcare provider, and single and multi state Blue Cross and Blue Shield plans.
Key partnerships
 Amazon Web Services (AWS) Oracle Cloud Infrastructure (OCI) Microsoft Azure Informatica
 Redhat/OpenShiftNot present

Present

Provider platform presence across the line of businesses
Commercial

Medicaid

MedicareSpecialty

Duals

TPAs

Blues

Payviders

Provider deployment flexibility across cloud and on-premise delivery
Private cloudPublic & hybrid cloudOn-premise

Provider platform presence across geographies
North America

United Kingdom

Rest of Europe

Rest of the World

Asia Pacific

Provider platform presence across buyer size
Small(annual revenue<US$1 billion)

Proprietary & Confidential. © 2023, Everest Global, Inc. | licensed to TriZetto (Cognizant)Medium(annual revenue=US$1-5 billion)Large(annual revenue>US$5 billion)

Very large(annual revenue>US$10 billion)

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Everest Group PEAK Matrix® for Healthcare Cloud-based Core Administration Platforms Provider 2023

TriZetto (Cognizant) | healthcare cloud-based core administration platforms profile (page 2 of 4)Offerings
NOT EXHAUSTIVE
Proprietary healthcare customer experience products (representative list)
Product

Details®

Facets® and QNXT™ contain provider credentialing capabilities within their respective core systems. Cognizant has a provider credentialing solution under development that will be
integrated to both QNXT and Facets, while also allowing integration to other core administration systems.

®

QicLink™ is a core administration system that is designed to support third-party administration of self-funded plans, thus maximizing efficiencies through automation; and enabling
seamless transactions between providers, members, and plans; delivering affordable, integrated access to innovative vendor solutions.

Facets and QNXT™
TriZetto QicLink™

®

®

®

TriZetto NetworX Suite®

NetworX Pricer , NetworX Modeler , and NetworX Payment Bundling Administration automate claims pricing to increase the speed, accuracy, and efficiency of provider contract
administration, support health plans in their compliance efforts with Medicare and Medicaid reimbursement standards, model provider contracts, and help manage the cost and quality ofcare through innovative reimbursement programs®

TriZetto® Touchless Authorization Processing (TTAP) is a solution that automates the prior authorization process, enabling greater cost and time savings than alternative solutions. The
cloud-based Software-as-a-Service (SaaS) application is accessed directly from provider’s desktops, automating all authorization functions in real time.

®

TriZetto® Connected Interoperability Solution supports compliance and delivers secure, on-demand data access with modular SaaS-delivered products that standardize and normalize data,
orchestrating it across systems and enabling authorized sharing through Application Programming Interfaces (APIs).

TriZetto Elements®

TriZetto® Elements is an end-to-end solution that supports the complex and strategic business requirements of government-sponsored health plans. Elements include solutions acrossenrollment and reconciliation, government and CMS data submission, and risk adjustment, which help health plans drive success and increase profitability for Medicare advantage,
managed Medicaid, and commercial exchange programs.

TriZetto Claims Data Manager

TriZetto Claims Data Manager is a solution that enhances revenue and helps Medicare Advantage Plans achieve compliance by ensuring proper RAPS submission to CMS and lowering
rejection rates.

TriZetto Touchless Authorization
Processing (TTAP)
TriZetto Connected Interoperability
Solution

®

®

®

®

TriZetto Claimsphere

TriZetto CareAdvance

TriZetto® Claimsphere® is a solution that helps healthcare organizations get a deeper understanding of their populations, deliver better care, reduce costs, and allows clients to decode
patient-specific clinical events across disparate data sources and use patient data to identify key issues impacting the scores.
The TriZetto CareAdvance platform transforms care management into a data-driven enterprise activity. Streamlining disease, case, and utilization management allows clients to deliver
targeted health information and wellness campaigns more effectively, while getting the most out of interactions with members and providers.

TriZetto Connected Health Solutions are Software-as-a-Service (SaaS) products that deliver on demand access to health plan information. Through user-friendly interfaces members,®
TriZetto Connected Health Solutions providers and other constituents can access the required on-demand information helping plans improve engagement, drive growth, and lower administrative costs

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Everest Group PEAK Matrix® for Healthcare Cloud-based Core Administration Platforms Provider 2023

TriZetto (Cognizant) | healthcare cloud-based core administration platforms profile (page 3 of 4)
Recent developments
NOT EXHAUSTIVE
Key events (representative list)
Event name

Type of event

Year

Details

Partnered with Microsoft

Partnership

2022

Partnered with Microsoft to deliver a digital health solution to enhance remote patient monitoring for improved medical carePartnership with AWS

Partnership

2022

Extended partnership with AWS, to jointly serve its customers with the solutions built on AWS, aiming to accelerate its customer transformations in 2023
and beyond

Expansion with dedicated Google
Business Group (GBG)

Investment

2021

Extended partnership with Google to work on dedicated Google Business Group (GBG) to help accelerate shared customers' cloud modernization journeys.
The GBG is an expansion of Cognizant's long-standing relationship with Google Cloud, extending combined service capabilities and joint solutions
development to accelerate client cloud transformation and meet the evolving needs of today's businesses

Acquired New Signature

Acquisition

2020

Acquired New Signature, a leader in cloud native business transformation, for expansion of Cognizant capabilities centered on Microsoft cloud solutions

Acquired 10th Magnitude

Acquisition

2020

Acquired 10th Magnitude, a leading cloud specialist focused exclusively on the Microsoft Azure cloud computing platform, to expand the Microsoft Azure
expertise within Cognizant’s new Microsoft Business Group, adding development and managed services hubs in major cities throughout the US

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Everest Group PEAK Matrix® for Healthcare Cloud-based Core Administration Platforms Provider 2023

TriZetto (Cognizant) | healthcare cloud-based core administration platforms profile (page 4 of 4)Everest Group assessment – Leader
Measure of capability:

Market impact
Market adoption

Portfolio mix

Value delivered

Low

High

Vision & capability
Overall

Vision and strategy

Technology
capability

Flexibility and ease Engagement andof deployment
commercial model

SupportOverallStrengths

Limitations

 Cognizant leverages its healthcare domain expertise and its long-standing prowess in the claims

 Cognizant can look to focus on improving its customer service and support and balance its talentspace by offering a best-in-class platform, TriZetto, comprising many solutions such as its
trademark FACETS and QNXT modules to provide highly contextualized and detailed functionalities
through its platform across all the lines of businesses

management given their correlation in generating client satisfaction
 While Cognizant offers varied innovative pricing models, it is perceived to be a premium-priced

provider and can consider boosting its price competitiveness to capture a larger market share The platform allows for a truly end-to-end capability with its robust and scalable solutions spanning

across extensive modules such as plan design, claims administration, and risk management byleveraging cutting-edge technology. For instance, Cognizant leverages its TriZetto Robotic Process
Automation across the value chain including claims Adjudication, and enrollment provider
maintenance to increase the benefits
 Cognizant continues to invest significantly in enhancing its core administration platform capabilities

along with a strong technology partnership ecosystem to deliver an innovative solution that further
brings out a fluid deployment construct to the clients
 Clients have cited that Cognizant’s ability in implementing platform changes and its platform

flexibility is its key strength

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Appendix

9Everest Group PEAK Matrix® for Healthcare Cloud-based Core Administration Platforms Provider 2023

Everest Group PEAK Matrix® is a proprietary framework for assessment ofmarket impact and vision & capability
Everest Group PEAK Matrix
High

Market impact
Measures impact created in the market

Leaders
Major Contenders

Aspirants

Low
Low

Proprietary & Confidential. © 2023, Everest Global, Inc. | licensed to TriZetto (Cognizant)Vision & capability
Measures ability to deliver products successfully

High

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Everest Group PEAK Matrix® for Healthcare Cloud-based Core Administration Platforms Provider 2023

Products PEAK Matrix® evaluation dimensions

Measures impact created in the market –captured through three subdimensions
Leaders

Market adoption

Portfolio mix
Diversity of client base acrossindustries, geographies, environments,
enterprise size class

Major Contenders

Market impact

Number of clients, revenue base,and YoY growth

Aspirants

Value delivered
Value delivered to the client basedon customer feedback andother measures

Vision & capability
Measures ability to deliver products successfully.
This is captured through five subdimensions

Vision and strategy

Technology capability

Flexibility and ease of deployment

Engagement and commercial model

SupportVision for the client and itself; future
roadmap and strategy

Technical sophistication
and breadth/depth across thetechnology suite

Configurability/customize-ability,
hosting and tenancy, integration,
governance, and security andcompliance

Progressiveness, effectiveness, andflexibility of engagement andcommercial models

Training, consulting, maintenance,and other support services

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Everest Group PEAK Matrix® for Healthcare Cloud-based Core Administration Platforms Provider 2023

FAQs

Does the PEAK Matrix® assessment incorporate any subjective criteria?
Everest Group’s PEAK Matrix assessment takes an unbiased and fact-based approach that leverages provider / technology vendor RFIs and Everest Group’s proprietary databases containing providers’ deals
and operational capability information. In addition, we validate/fine-tune these results based on our market experience, buyer interaction, and provider/vendor briefings.
Is being a Major Contender or Aspirant on the PEAK Matrix, an unfavorable outcome?
No. The PEAK Matrix highlights and positions only the best-in-class providers / technology vendors in a particular space. There are a number of providers from the broader universe that are assessed and do
not make it to the PEAK Matrix at all. Therefore, being represented on the PEAK Matrix is itself a favorable recognition.
What other aspects of the PEAK Matrix assessment are relevant to buyers and providers other than the PEAK Matrix positioning?
A PEAK Matrix positioning is only one aspect of Everest Group’s overall assessment. In addition to assigning a Leader, Major Contender, or Aspirant label, Everest Group highlights the distinctive capabilities
and unique attributes of all the providers assessed on the PEAK Matrix. The detailed metric-level assessment and associated commentary are helpful for buyers in selecting providers/vendors for their specificrequirements. They also help providers/vendors demonstrate their strengths in specific areas.
What are the incentives for buyers and providers to participate/provide input to PEAK Matrix research?

 Enterprise participants receive summary of key findings from the PEAK Matrix assessment
 For providers– The RFI process is a vital way to help us keep current on capabilities; it forms the basis for our database – without participation, it is difficult to effectively match capabilities to buyer inquiries– In addition, it helps the provider/vendor organization gain brand visibility through being in included in our research reports

What is the process for a provider / technology vendor to leverage its PEAK Matrix positioning?

 Providers/vendors can use their PEAK Matrix positioning or Star Performer rating in multiple ways including:– Issue a press release declaring positioning; see our citation policies– Purchase a customized PEAK Matrix profile for circulation with clients, prospects, etc. The package includes the profile as well as quotes from Everest Group analysts, which can be used in PR– Use PEAK Matrix badges for branding across communications (e-mail signatures, marketing brochures, credential packs, client presentations, etc.)
 The provider must obtain the requisite licensing and distribution rights for the above activities through an agreement with Everest Group; please contact your CD or contact us
Does the PEAK Matrix evaluation criteria change over a period of time?
PEAK Matrix assessments are designed to serve enterprises’ current and future needs. Given the dynamic nature of the global services market and rampant disruption, the assessment criteria
are realigned as and when needed to reflect the current market reality and to serve enterprises’ future expectations.

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Everest Group PEAK Matrix® for Healthcare Cloud-based Core Administration Platforms Provider 2023
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