About Change Healthcare

Change Healthcare Inc. operates as a leading healthcare technology company. The company focuses on accelerating the transformation of the healthcare system through the power of its Change Healthcare platform. The company provides data and analytics-driven solutions to improve clinical, financial, administrative, and patient engagement outcomes in the U.S. healthcare system. The company’s platform and comprehensive suite of software, analytics, technology enabled services and network solutions drive improved results in the complex workflows of healthcare system payers and providers by enhancing clinical decision making, simplifying billing, collection and payment processes, and enabling a better patient experience. The company’s network, one of the strongest clinical and financial healthcare networks in the U.S., was created to facilitate the transfer of data among participants. With insights gained from its experience, applications and analytics portfolio, and its services operations, it has designed analytics solutions that include trusted, industry-leading franchises supported by extensive intellectual property and regularly updated content. In addition to the advantages of scale, the company offers the collaborative benefits of an important partner to the healthcare industry. The company seeks to establish and develop enduring relationships with each customer through solutions that deliver measurable results for their complex daily workflows. The company’s customer retention rate for its top 50 provider and top 50 payer customers was 100% for the fiscal year ended March 31, 2022. The Pre-Visit, which includes provider selection, scheduling an appointment, ensuring coverage and pre-authorization, medical record sharing and review, and understanding required payments. The Visit (or visits), during which financial clearance is provided, imaging and other clinical activities are managed, and medical necessity is ensured. The Post-Visit, which typically requires the resolution of payment, claims remittance and processing, and on-going patient engagement. This stage is increasingly important today as the industry moves toward value-based care and payment models. The company’s analytics-driven solutions are designed to improve delivery of care through better clinical decision-making, and to simplify billing and payment functions by reducing administrative errors and improving documentation. Strategy The key elements of the company’s strategy are to develop, augment and commercialize capabilities at scale; maximize wallet share with customers through cross-selling; deliver comprehensive, end-to-end, modular solutions to customers; and use its data assets to deliver tangible value to customers. Solutions The company offers clinical, financial, and patient engagement solutions in three business segments—Software and Analytics, Network Solutions, and Technology-Enabled Services—that facilitate significant collaboration and interoperability to create a stronger, better coordinated, increasingly collaborative, and more efficient healthcare system. Software and Analytics The company’s software solutions seek to enable its customers to achieve financial performance, operational excellence, and payment and network optimization, ultimately helping them navigate the industry’s transition to value-based care. In the Software and Analytics segment, the company provides solutions for revenue cycle management, provider network management, payment accuracy, value-based payments, clinical decision support, consumer engagement, risk adjustment and quality performance, and imaging and clinical workflow. Network Solutions The company leverages its networks to enable and optimize connectivity and transactions among healthcare system participants. Through the company’s Network Solutions segment, it provides solutions for financial, administrative, and clinical and pharmacy transactions, electronic payments and aggregation and analytics of clinical and financial data. Technology-Enabled Services The company provides expertise, resources, and scalability to allow its customers to streamline operations, optimize clinical and financial performance, and focuses on patient care. Through its Technology-Enabled Services segment, the company provides solutions for financial and administrative management, value-based care, communication and payment, pharmacy benefits administration and healthcare consulting. Software and Analytics Network and Financial Management: The company helps commercial and government payers improve claims operations performance, payment model innovation, and provider network management through a comprehensive solution supporting payers across the entire payment continuum in the transition to value-based care and alternative payment models. Value-Based Payment Analytics: The company combines a cloud-based analytics platform with clinically validated, transparent Episodes of Care to coordinate Primary Care Providers and Specialists in the effective transition to alternative payment models. Payment Accuracy Analytics and Services: The company’s comprehensive suite of solutions is designed to help payers combat risk of fraud, waste, and abuse at every stage of the claim, from pre-submission to post-payment. Risk Adjustment and Quality Performance: The company helps payers and risk-bearing providers improve financial performance by supporting reimbursement for government-sponsored health plans – including risk adjustment and quality measures, such as the National Committee for Quality Assurance’s (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) – for the Medicare, Medicaid, and Commercial Affordable Care Act markets. Decision Analytics: The company provides a comprehensive set of analytics-driven solutions for risk adjustment and quality performance that aligns with how government-sponsored plans are reimbursed. Clinical Review Services: The company provides solutions for medical records retrieval, coding, and abstraction for payers who want to increase incremental revenue and quality ratings for (National Committee for Quality Assurance) NCQA’s HEDIS and the Star Rating Program (a CMS system to help beneficiaries compare performance and quality). Consumer Engagement: The company helps commercial and government payers adapt to the evolving needs of a more value-based, consumer-driven environment with consumer-facing tools used to support enrollment and ongoing health management processes. The company’s consumer engagement solutions help payers respond to many of the industry’s most pressing consumer engagement challenges, from addressing social determinants of health to engaging high-need populations, such as dual eligible individuals. Member Enrollment and Outreach: The company provides member-centric solutions for payers—focusing on Medicare and Medicaid programs—to improve revenue, increase member satisfaction, and improve engagement in maintaining or improving their health. The company has helped managed care payers add incremental revenue through dual enrollment. Additionally, the company’s enrollment Artificial Intelligence (AI) services pinpoint those individuals with the highest likelihood to qualify for full or partial Medicare and Medicaid dual eligibility. Clinical Decision Support: The company’s clinical criteria, InterQual, assists payers, providers and government organizations in making clinically appropriate medical utilization decisions to help determine the right care, at the right time, and at the right cost. Revenue Cycle Management: The company provides end-to-end revenue cycle management workflow and analytics to streamline reimbursement and time-to-revenue for hospitals, physician offices, laboratories, and other ancillary care providers by providing timely insights that reduce denials. Imaging and Clinical Workflow Solutions: The company helps providers improve clinical, operational, and financial performance through enterprise imaging and care delivery solutions for acute and post-acute care settings. The company has built and are building, from the ground up, cloud-native solutions to showcase the flexible nature of cloud services and delivery. The cloud-native network will enhance and optimize medical imaging data, enabling providers to improve clinical, financial, and operational outcomes. Network Solutions The company’s networks provide connectivity that benefits all major healthcare stakeholders, including commercial and governmental payers, employers, hospitals, physicians, laboratories, pharmacies, and consumers. Medical Network: The company’s network provides support for healthcare financial and administrative transactions, including eligibility, claims, durable medical equipment, electronic remittance advice, claim status, pre-authorization, and medical attachments. The company’s Medical Network is integrated with its payments network, which allows payers and providers to reconcile consumer out-of-pocket cash and credit card payments with payer electronic funds transfer and check payments to settle bills and claims. Dental Network: The company provides eligibility, claims, electronic remittance advice, and payment solutions to dental practices primarily through software channel partners. The company’s solutions further simplify claims through its attachment technology, which tightly integrates claims processing workflows to ensure only essential attachments required by a payer are connected to a claim and delivered according to payer preferences. Clinical Exchange Network: The company’s Clinical Exchange Network provides an efficient mechanism for EHRs, laboratories, and pharmacies to connect with each other and maintain regulatory certifications without the cost of expensive and redundant direct connections. MedRx Network: The company’s medical pharmacy network provides pharmacies with connectivity to commercial and government payers, supporting billing medical claims, such as durable medical equipment and immunizations, directly from the pharmacy management system. CommonWell Health Alliance: As the national service provider for CommonWell Health Alliance, the company supports an industry-wide interoperability effort to make available silos of data that reside within care settings and disparate health IT systems. The company’s services for CommonWell members include registration and unique identification of each individual enrolled; record locator services; linking of each individual’s clinical records across the care continuum; and data query and retrieval to enable caregivers to search, select and receive data. Electronic Payments: The company’s electronic payment solutions support both business-to-business (B2B) and consumer-to-business (C2B) payments. Payer Solutions: The company offers payers the ability to optimize distribution of payments and remittances in the most efficient manner via electronic funds transfer, direct payment, cards or check. The company also assists its customers in automating these processes. Provider Solutions: The company offers providers the ability to digitize payments and remittances, increasing automation and efficiency in payment posting processes and reducing the amount of paper documents. Consumer Payment Solutions: The company helps providers efficiently bill consumers and offer consumer-friendly options to help reduce bad debt while enhancing the consumer billing and payment experience. Data Solutions: The company helps address increasing demands for data to support analytical needs related to performance improvement, consumer engagement, and value-based care. Data Platform: The company enables its customers to acquire and aggregate clinical, financial, and operational data from across the care continuum, analyze the data and make it available through applications or via direct feeds to a customer’s existing enterprise data warehouse and other analytics systems. Data Commercialization: The company provides de-identified data feeds informed by regulatory compliant formats and create applications and tools directly for customers or via third-party channel partners. Data Science as a Service: The company provides secure access to de-identified, patient-level claims data – including diagnoses and care prescriptions – along with social determinants of health, behavioral health, and other novel data for customers who want privacy-compliant healthcare analytics at scale. Pharmacy Solutions: The company offers a comprehensive suite of end-to-end pharmacy solutions that help streamline operations and improve financial results for both independent and chain pharmacies. Pharmacy Management: The company’s scalable pharmacy management system helps its customers quickly adapt to changing market and business requirements with configurable workflows and dispensing rules that streamline in-store processes and improve staff efficiency. Pharmacy Network: The company’s network helps pharmacies submit claims to any third-party processor; perform custom claims; edit claims that suit unique pharmacy requirements; streamline eligibility checks with access to coverage information for more than 270 million individuals; and reduce the financial burden of co-pays and medication adherence while driving revenue. Revenue Cycle Management: The company’s modular pharmacy revenue cycle management suite offers tools for third-party submission and reconciliation, outsourced chasing claims, contract management, appeal submission, and tracking services. Pharmacy Analytics: The company helps pharmacies drive real-time, point-of-sale actions that enhance revenue with robust analytics that reveal insights into all areas of their business––from chain to individual store––with visualizations, dashboards, and reports for monitoring business operations, improving margins, minimizing costs/risks, and supporting health and wellness initiatives. Technology-Enabled Services Revenue Cycle Management: The company has a demonstrated ability to help improve collections, optimize operational efficiency, and enhance patient experience. Patient Access Services: The company enables health systems and physician practices to provide a broad range of patient access services to their patients. The company leverages call center technology with the flexibility to utilize EHR and practice management capabilities, providing a single source of accountability with reporting and continuous quality monitoring. Revenue Integrity Services and Consulting: The company’s Revenue Integrity services help providers mitigate risk, and include charge audit services, coding augmentation, coding quality audit, clinical documentation improvement staffing, and compliance review. Hospital Reimbursement Management Services and Physician Revenue Cycle Management Services: The company delivers billing and accounts receivable management to address government, commercial, and self-pay payments for hospitals, health systems, independent and hospital-employed physician practices, fire and emergency medical service agencies, and other healthcare organizations, such as independent and hospital-employed laboratories. Accountable Care Services: The company provides a broad scope Business Process as a Service (BPaaS) solution to payers, accountable care organizations, at-risk providers, and government agencies to successfully transition from fee-for-service reimbursement to payment models that reward high-quality and cost-effective care. The company provides an enterprise class benefits administration and claims processing platform, fully delegated, licensed third-party administration and Utilization Review Accreditation Commission (URAC) accredited clinical support services. Network Development and Physician Recruiting: The company helps commercial payers and managed care organizations successfully develop, manage, and scale clinically integrated networks and IPA networks. Risk Management and Population Health Services: The company enables providers to drive growth and improve margin performance under all value-based payment models, ranging from capitation to shared savings programs. Third-Party Administration: The company provides fully delegated, licensed third-party administration services that enable risk-bearing providers and payers to reduce the burden of foundational health plan administration, allowing for greater focus on strategic activities, such as new product development and member engagement. Business Process as a Service (BPaaS): At the core of its BPaaS solution is the company’s CMS compliant, real-time benefits administration and claims processing platform for all lines of business built entirely on contemporary technology. The company’s platform offers unlimited flexibility in defining benefit plans, provider contracts, and core business processes using healthcare business rules language that can be read and written by non-technical people. Communications and Payment Services: The company provides communication and payment solutions for payers, providers, channel partners and other stakeholders in the healthcare system. Communications and Payments: The company helps payers produce and distribute explanation of benefits, explanation of payments, checks, claims and correspondence. Patient Billing and Statements: For providers and channel partners, the company manages patient statements and related correspondence, integrated with its digital payment solution. Pharmacy Benefits Administration (PBA): The company’s PBA solutions provide healthcare management and other administrative services for pharmacy payers and state Medicaid programs, as well as claims processing and other administrative solutions, in real-time, according to customer benefit plan designs, and present a cost-effective alternative to an in-house pharmacy claims adjudication system. Consulting: The company’s healthcare consulting solutions help healthcare customers analyze, develop and implement business and technology strategies that are designed to align with healthcare trends and overall business goals. Customers The company generally provides solutions to payer and provider customers on a per transaction, per document, per communication, per member per month, per provider per month, monthly flat-fee, contingent fee, or hourly fee, and software license, with recurring maintenance fee, basis. The company’s customer contracts are generally one to three years in term and automatically renew for successive annual terms unless terminated. Payers: The payer market primarily consists of national commercial insurers, regional private insurers, BlueCross Blue Shield plans, Medicare/Medicaid plans, provider-sponsored payers, third party administrators, emerging technology and data-driven health plans and other specialty health benefits insurers. The company is directly connected to their workflows and administrative and clinical systems and provide products and services to nearly all payers. Providers: The provider market consists of hospitals and health systems, physician practices, dentists, pharmacies, skilled nursing facilities, home health agencies, telehealth providers, senior care facilities, laboratories, and other healthcare providers. The company has contractual or submitter relationships with these providers, directly or through its channel partners. Seasonality The nature of the company’s customers’ end-market results in moderate seasonality reflected in revenue differences during the year with a slightly greater positive variance in its fiscal fourth quarter (year ended March 31, 2022) related to the regulatory impact of data submission deadlines due to HEDIS, which may drive timing of analytics activity. Quarter to quarter financial performance may vary from historical seasonal trends as the company further expands and diversifies its business and increase the portion of the company’s revenue generated from new offerings. Regulations The company is directly subject to the HIPAA (the Health Insurance Portability and Accountability Act of 1996, as amended by the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH Act) and more recent laws, such as the 21st Century Cures Act (the Cures Act) (Public Law 114-255), and Public Law 116-321 (the laws and regulations collectively, HIPAA)) privacy and security regulations as a Covered Entity with respect to its operations as a healthcare clearinghouse. History The company was founded in 2016. It was incorporated in 2016. The company was formerly known as HCIT Holdings, Inc. and changed its name to Change Healthcare Inc. in 2018.