Change Healthcare

Change Healthcare
Name	Change Healthcare
Type	Public (formerly)
Industry	Healthcare information technology
Founded	2007 (through mergers)
Headquarters	Nashville, Tennessee
Products	Revenue cycle management, claims processing, payment solutions, analytics

Change Healthcare is a United States-based healthcare technology and services company providing revenue cycle management, claims processing, payment solutions, analytics, and network services to healthcare providers, payers, and pharmacies. The company emerged from a series of mergers and acquisitions involving legacy firms in healthcare information technology and insurance administration, operating across clinical, financial, and pharmacy domains. Change Healthcare served major hospitals, health systems, insurance companies, and retail pharmacy chains until a significant corporate transaction altered its independent status.

History

Founded through consolidation, the corporate lineage traces to legacy firms such as McKesson Corporation, Emdeon, RelayHealth, HMS Holdings Corporation (HMS), and other regional billing and clearinghouse providers that expanded during the 1990s and 2000s. Strategic moves during the 2010s linked corporate events to transactions involving UnitedHealth Group, Optum, Cerner Corporation, and Express Scripts, reflecting consolidation trends in the healthcare technology market. Major milestones included the acquisition of clearinghouse platforms, expansion of pharmacy benefit management interfaces, and operational integration aligned with mergers like the McKesson sale of certain businesses and the rise of integrated service providers serving Kaiser Permanente and national health plans. The firm’s trajectory intersected with regulatory reviews by agencies such as the United States Department of Justice and market developments following landmark deals in the healthcare mergers and acquisitions space.

Corporate structure and ownership

Corporate structure evolved through acquisitions, divestitures, and private equity transactions involving firms such as McKesson Corporation, UnitedHealth Group, OptumRx, and private investors connected to major buyouts. Ownership history includes stakes held by strategic corporate buyers and investors active in the healthcare information technology sector. Governance and board composition drew directors and executives with backgrounds at organizations such as Cigna Corporation, Anthem, Inc., Aetna, and global consulting firms linked to Deloitte and McKinsey & Company. The company’s status, at times public and at times privately held, attracted scrutiny from antitrust enforcers including the Federal Trade Commission (United States) during proposed combinations affecting national networks and payer-provider relationships.

Products and services

Product offerings spanned revenue cycle management platforms used by large health systems such as Mayo Clinic, Cleveland Clinic, and regional hospital chains, alongside claims clearinghouse services utilized by national payers like Blue Cross Blue Shield Association plans and pharmacy networks aligned with CVS Health and Walgreens Boots Alliance. Services included claims adjudication, eligibility verification, prior authorization routing, payment reconciliation, clinical decision support integration with electronic health record vendors like Epic Systems Corporation and Cerner Corporation, and pharmacy benefit connectivity with managers like Express Scripts and Prime Therapeutics. Analytics and value-based care tools supported programs run by organizations including Centers for Medicare & Medicaid Services initiatives and accountable care organizations modeled after Pioneer ACO frameworks.

Technology and operations

Operational technologies combined large-scale data centers, cloud computing partnerships with providers such as Amazon Web Services, Microsoft Azure, and enterprise integration with health information exchanges like CommonWell Health Alliance and Carequality. Interoperability efforts engaged standards overseen by Health Level Seven International and initiatives under the Office of the National Coordinator for Health Information Technology to implement HL7 FHIR APIs, support electronic health record integrations, and maintain secure messaging compatible with Direct Project protocols. Scalable transaction processing handled billing formats such as X12 and ASC X12 standards, and security practices aligned with frameworks referenced by the National Institute of Standards and Technology.

Regulatory and legal issues

Regulatory matters involved reviews by the United States Department of Justice, competition assessments referencing the Clayton Antitrust Act and the Hart–Scott–Rodino Antitrust Improvements Act, and compliance obligations under HIPAA. Legal disputes and consent decrees touched on data security, contractual performance with large clients including national hospital systems and pharmacy chains, and investigations into potential competitive harms cited by state attorneys general in multistate coalitions. The company’s participation in sector consolidation placed transactions under scrutiny by regulatory bodies such as the Federal Trade Commission (United States) and informed rulings in notable antitrust enforcement actions in the healthcare sector.

Financial performance

Financial metrics reflected revenue derived from recurring software-as-a-service contracts, transaction fees from claims clearinghouse operations, and professional services tied to revenue cycle outsourcing for customers like integrated delivery networks and community hospitals. Revenue trends paralleled spending patterns of major payers including UnitedHealth Group and the budgeting cycles of academic medical centers such as Johns Hopkins Hospital. Capital structure at times involved debt financing instruments underwritten by investment banks with ties to Goldman Sachs and JPMorgan Chase, and valuations influenced by comparable transactions involving Cerner Corporation and other healthcare IT consolidators.

Industry impact and partnerships

The company’s platform influenced market dynamics across payer-provider interfaces, facilitating partnerships with pharmacy chains such as CVS Health, Walgreens Boots Alliance, and grocer-affiliated clinics, and collaborations with electronic health record vendors including Epic Systems Corporation and Cerner Corporation. Strategic alliances with clearinghouses, pharmacy benefit managers like Express Scripts and Prime Therapeutics, and participation in standards bodies such as Health Level Seven International shaped interoperability adoption and payment modernization initiatives endorsed by Centers for Medicare & Medicaid Services policy proposals. Through technology deployments and network effects, the firm impacted revenue cycle automation, claims throughput speeds affecting state Medicaid programs, and analytics used by national quality measurement programs administered by organizations like National Committee for Quality Assurance.

Category:Health information technology companies