Inovalon Insights

by "Inovalon" on 8/27/2014 10:47 AM

As summer comes to an end, insurers need to think seriously about December. The first estimate calculations from CMS will come in the middle of December, but only for those who register in September or early October and quickly begin setting up their servers and testing data submissions.

Fortunately, CMS’s recent release of its EDGE server implementation timeline means we can clearly see all the tasks involved and the deadlines to hit.

by "Inovalon" on 8/20/2014 12:21 PM

It seems counterintuitive, but in healthcare, it’s often the things you can’t see that are most important. Providers and payers need to see the patient and the patient’s medical records, of course, but finding where care is missing is perhaps the most critical and challenging issue these days.

Care improvement experts from the government and elsewhere have endorsed the idea of care gaps being addressed using a medical record review (MRR) process in which medical data is retrieved from providers’ electronic  health records (EHRs). The data retrieved from EHRs can then be used to

by "Inovalon" on 7/7/2014 11:59 AM

In June, the Centers for Medicare & Medicaid Services (CMS) threw another twist into the already complicated EDGE server game. On June 4, CNBC reported that insurers selling Affordable Care Act (ACA) plans are allowed to use Amazon’s Web Services cloud to host the de-identified data they’re required to share with CMS.

For some plans, this is excellent news. In a recent conference call, CMS said the Amazon option will cost between $6,000 and $24,000 per year for the service, depending on plan size. This contrasts with the cost to purchase an EDGE server, which can run from $10,000 for small plans up to $50,000 for large plans, not including maintenance costs.

by "Inovalon" on 5/22/2014 9:50 AM

For much of the 20th century, the pharmacy was a community gathering place, dispensing medicine, advice, and even ice cream. Over time, pharmacies have evolved into mini department stores, and today they are expanding to offer patient care with in-store clinics.

by "Inovalon" on 4/15/2014 1:00 PM

The first question people tend to ask about predictive modeling is fundamental: does it work? The answer is a resounding yes. The national average for the 2013 to 2014 star rating year increase was 5.29 percent. During the same period, the average health plan that engaged with Inovalon’s Star Advantage® clinical and quality outcomes improvement solution realized a 2013 to 2014 star rating year performance increase of 14.5 percent, nearly three times the average national increase.

The second question—how does predictive modeling work?—requires a longer answer. Inovalon’s Mike Burgin, Vice President of Clinical and Quality Outcomes, and Hemanth Doma, Director of Healthcare Data Analytics, explained the process during one of Inovalon’s thought-leadership webinars.