End-to-end revenue cycle management outsourcing is gaining momentum, prompting healthcare organizations to assess the vendor market for their specific needs.

Market research firm, KLAS, recently published a report detailing client satisfaction with major end-to-end revenue cycle management (RCM) vendors, including Ensemble, R1 RCM, Guidehouse and Optum. The report also shows that market energy in this space has increased in the past two years, with most major outsourcing vendors gaining new contracts between July 2023 and May 2025.

KLAS defined end-to-end RCM outsourcing as hospital-based organizations outsourcing all or key components of patient access, health information management and business office departments to a third-party firm on an ongoing basis. The outsourcing arrangement also typically lasted at least five years and involved rebadging, in which people are transferred to another organization.

End-to-end RCM outsourcing vendor rankings

Based on client interviews, KLAS ranked key end-to-end RCM outsourcing vendors based on client loyalty, operations, relationship, services and value. KLAS also asked clients to rate their satisfaction with their vendor's impact on the denials rate, cash collections, days in accounts receivable and patient experience.

The 2025 Best in KLAS winner, Ensemble, ranked the highest for overall performance, scoring 95.1 points out of 100. The vendor had the highest client satisfaction across all metrics in the data sample, KLAS reported.

Notably, Ensemble clients, which were primarily organizations with net patient revenue of less than $5 billion, highlighted "deep partnerships" from early during the sales process through the post-implementation phase. They also valued a "structured governance process, collaborative leadership, and frequent, structured communication channels." Clients also expressed enthusiasm for Ensemble's investments in advanced technology and its expansion into payer relations for contract negotiations.

Guidehouse earned the next highest overall performance score with 93.8 points, although KLAS noted limited client data. The vendor primarily served smaller organizations with less than $500 million in net patient revenue. However, the small group responding to KLAS reported high satisfaction and optimism, highlighting Guidehouse's "knowledgeable, flexible staff" and "achieved outcomes."

KLAS also had limited data on Optum's end-to-end RCM outsourcing services, but gave the vendor a score of 61.9 points. The small group of clients was generally satisfied with access to Optum's technology. However, some felt neutral about their future with the vendor, citing staff turnover, slow progress on key initiatives and persistent backend challenges. Most of the small group were dissatisfied with Optum's outcomes across cash collections, denials rate and patient experience.

Finally, R1 RCM earned an overall performance score of 55.6 points. Clients, who largely belonged to organizations with net patient revenue over $5 billion, reported low satisfaction with the vendor because of long-standing issues that impacted outcomes and perceived slow execution. The clients interviewed by KLAS also sought additional, deeper support. They cited challenges with staff turnover, lack of strategic coordination across teams and poor follow-through on targets and commitments.

However, recent changes at R1 RCM, including leadership shifts and new investments (e.g., Palantir partnership), have spurred optimism about the vendor's future among clients.

KLAS also reported that R1 RCM and Ensemble have a significant level of AI investment versus Guidehouse and Optum, which KLAS said had minimal and moderate investment, respectively.