Retrospective Risk Score Accuracy Improvement Solution

Retrospective Risk Score Accuracy Improvement Solution

Risk adjusted Medicare Advantage, managed Medicaid, commercial ACA health plans, require solutions to improve risk score accuracy. Inovalon’s Client Cloud Access (CCA) Retrospective Risk Score Accuracy Improvement Solution, provides data-driven, end-to-end insight and predictability from seamless data integration, advanced cloud-based predictive analytics, Interoperability or other logistical capabilities for targeted clinical record data extraction, comprehensive quality control processes, and insightful, near real-time reporting. The result is improved clinical diagnosis data accuracy, risk score accuracy insight, and financial performance.

With clients’ goals in mind, Inovalon offers a flexible and modular solution that can be tailored to meet an organization’s unique risk score accuracy needs, including: Gap Identification Analytics, Clinical Data Extraction and Review, and a Comprehensive Retrospective Solution, all leveraging Inovalon’s data integration and validation capabilities.

In addition, Inovalon can also assist organizations with results processing and regulatory submissions.

Integrate Diverse Datasets

Inovalon's data integration and validation solution, iPORT™ accepts clients’ data in its native format and is able to seamlessly and securely integrate, normalize and validate the data in a rapid, reliable and compliant manner. All data is integrated and processed on an ongoing basis, and subjected to more than 1,100 data integrity checks and data management processes to ensure highest security, privacy and accuracy. Experts alert health plans and resolve issues to achieve an industry-leading array of comprehensive data feeds informing Inovalon’s cloud-based analytical systems.

Gap Identification Analytics

With datasets imported, cross-walked, and mapped into the risk adjustment database, thousands of proprietary, clinically-driven algorithms are applied within the Inovalon Predictive Clinical Insights System (PCIS™) to identify which diagnoses and comorbidities may exist that are incompletely or improperly reflected within the health plan’s claims data systems along with a real-time impact analysis.

Clinical Data Extraction & Review

The Inovalon nationwide employee network of highly trained clinical reviewers deliver comprehensive clinical data and case review expertise, all of which is enabled by professional project management and leading-edge EHR and paper-based clinical data extraction technology.

Comprehensive Retrospective Solution

Inovalon’s comprehensive retrospective solution combines the benefits of our Gap Identification Analytics and Clinical Data Extraction and Review to offer a full service retrospective risk score accuracy program. Inovalon’s adaptable and rapid integration at all stages of the process, as well as a flexible and modular approach, help organizations achieve business goals in the most effective and cost-efficient manner.

Modular & Flexible Approach
Integrated, efficient, and customizable solutions tailored to meet your risk score accuracy improvement needs, as well as a comprehensive solution.
Expanding Data Analytics & Clinical Algorithms
Data-driven clinical templates informed by more than 38 billion medical events to continually improve your member’s risk score accuracy.
Innovative Technologies for Clinical Data Review
Guided clinical tools, including NLP, offshore capabilities to create efficiency, and EHR Interoperability to minimize abrasion in your provider community.
Cohesive Quality Assurance & Compliance Processes
Sophisticated, rigorous processes for comprehensive measurement, tracking and continuous improvement of risk score accuracy outcomes.
Retrospective Program Management
Adjustable program components assembled to meet your operational and financial goals.
Strategic Advisory Services
Experienced subject matter experts from Inovalon and Avalere will work in partnership with you to meet your risk score accuracy improvement goals and support actuarial service.