Inovalon Insights

by "Inovalon" on 12/9/2013 1:19 AM

On January 1, 2014 the Health Insurance Exchange (HIX) Marketplace will be operational and it is becoming increasingly clear that most state exchanges in 2014 will have risk pools with sicker, older members than expected or prepared for. Reasons include:

  1. Lower enrollment in most state exchanges due to continuing website enrollment technical issues
  2. Lower federal tax disincentives in the first year in comparison to future years
  3. Higher premiums in many states for younger would-be enrollees ( the ‘young invincibles’)

The HIX Marketplace is a showcase for accelerated Darwinism for Qualified Health Plans (QHPs).

How can insurer’s best be equipped with these realities? The answer lies within the data, and from that risk score accuracy will be more important than ever.

by "Inovalon" on 10/31/2013 10:56 AM

Star scores continue to direct quality incentive bonuses; however, there has not been as much focus on as patient retention and selection preference. When beneficiaries compare plans on the Medicare Plan Finder (, a plan’s Overall Star Rating and Low Performing icon is displayed as possible criteria for enrollee decision-making.

Further, an early confirmation of the influence of Star Rating scores on membership selection is verified by a study reviewed in The Journal of the American Medical Association (January 16, 2013 Volume 309, No. 3 article​​)​​ which stated that among the 952,352 first-time enrollees in 2011, a 1-star higher rating was associated with a 9.5 (95% CI, 9.3-9.6) percentage-point increase in likelihood to enroll in a given plan.

Overview of 2014 Results:

by "Inovalon" on 10/22/2013 2:37 AM

As the Affordable Care Act (ACA) continues to unfold, the Health Insurance Exchange (HIX) Marketplace will provide a one-stop shop for individuals and small businesses to compare and purchase health insurance coverage. Today there are currently 31 million people enrolled in individual and small group plans. The Congressional Budget Office expects approximately 7 million additional enrollees through the individual and small business exchanges in 2014 alone. By 2019, total enrollees in individual and small group plans is estimate to reach 57 million.

by "Keith R. Dunleavy, M.D." on 9/26/2013 3:05 AM

Healthcare has been on a course of inevitably progressive complexity. The question is not whether it will continue at its currently torrid pace of expansion, but rather, how does one survive - and even thrive - within it?

Thriving in healthcare amid the quickly changing landscape requires leveraging big data and its analysis, along with sophisticated technology, to empower multidimensional member-specific and provider-specific interventions, integration with providers’ electronic health record (EHR), and interventions with members that go beyond a telephone call. We see healthcare quickly changing and innovation is imperative.

We welcome you to our official blog, Inovalon Insights, where we will comment on industry trends, share what we learn as we innovate, and discuss ways leaders in healthcare are joining together to drive improvement in healthcare.