Most health plans did not set out to build a patchwork of vendors. It happened one urgent need at a time: a risk adjustment tool here, a quality reporting platform there, a separate chart retrieval vendor, and yet another system for regulatory submissions. Each decision made sense on its own. Together, they leave a growing plan managing four or five vendor relationships to do what should function as one connected process: understand a member’s risk and quality picture, get the clinical documentation to support it, and submit it correctly.
The cost of point solutions adds up quietly
A national payer with a large internal team can absorb several specialized vendor relationships as a staffing problem. Your plan feels the same sprawl differently — as a structural drag. Every additional vendor means another contract, another data format, and another handoff where information can go stale between systems never designed to talk to each other.
The plans feeling this most acutely are often the ones growing fastest, since membership growth expands risk adjustment, quality, chart retrieval, and CMS submissions work faster than a smaller-scale vendor setup can absorb it.
What a connected platform actually replaces
A payer platform approach consolidates the work of several point solutions into one connected system, built around three functions that are usually purchased separately:
Analytics that identifies risk adjustment, quality, and health equity opportunities from claims and clinical data, so a plan knows where its gaps actually are before spending on outreach.
Clinical Data Exchange that retrieves the supporting data directly from providers’ own EHRs, closing the loop between identifying a gap and proving it was addressed.
Comprehensive Submissions that takes validated, coded data through to CMS submission, reducing the manual handoffs where risk adjustment revenue most often gets lost or delayed.
When these three functions run on one platform instead of three separate vendor relationships, a plan is not just saving on contract overhead. It is closing the gaps between systems where accuracy, timeliness, and revenue tend to leak out today.
What gets missed without it
The costs that show up in a vendor contract review are only part of the story. Clinical quality teams often invest heavily in provider outreach only to watch HEDIS gaps stay open and Star Ratings fail to reflect care the network actually delivered, because the documentation proving it never made it back in usable form.
The same fragmentation strains the provider relationship. Every data request sent to a provider who already documented that encounter reads as one more administrative ask, not fewer — exactly what a connected network is supposed to prevent.
Backed by infrastructure already proven in the field
This is not a hypothetical capability. In May 2026, Veradigm launched its Health Network Architecture, connecting the EHR, practice management, clearinghouse, and patient portal systems independent practices already use into one real-time view. As Tehsin Syed, Veradigm’s Chief Product and Technology Officer, said at launch, “For years, healthcare technology added a new tool for every new requirement, but never a way to make them work together. Veradigm Health Network Architecture changes that.”
For payers, the impact is direct. Care gaps that close during the visit lower outreach costs and improve risk adjustment coding accuracy, and chart retrieval that once took weeks now takes minutes, connected through standards-based FHIR APIs rather than months-long custom integrations. Veradigm’s Payer Platform, spanning analytics, clinical data exchange, and comprehensive submissions, runs on that same connected infrastructure, supporting more than 80 health plan clients and over 20 million patients today, and recognized as the number one Black Book Payer Analytics provider and number two in KLAS Risk Analytics.
Where to start
For most plans, the question is not whether risk adjustment, quality reporting, chart retrieval, and submissions all matter. It is whether those functions are working together or working around each other. A Payer Platform Assessment is a straightforward way to see how many separate systems your plan is currently stitching together, and what a single connected platform would look like in their place.
To learn more or schedule a Payer Platform Assessment, contact your Veradigm Account Executive or visit Veradigm.com
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
