Triple-S Salud and American Health Medicare Partner with Inovalon

Leading Health Plan Implements Inovalon's Integrated Solution to Support Focus on CMS 5-Star Quality Ratings

BOWIE, Md. – Jan. 24, 2012 – Inovalon, Inc., a leading provider of data-driven healthcare solutions, today announced that Triple-S Salud, also known as BlueCross BlueShield of Puerto Rico, and its subsidiary American Health Medicare, have selected Inovalon's Star Advantage™, Prospective Advantage® and INDICES™ systems in a multi-year engagement, providing an integrated solution for identifying and closing gaps in care, quality, assessment and documentation. The platform leverages the nation’s most widely used healthcare quality measurement system, large-scale healthcare dataset analytics, and a nationwide clinical operations infrastructure to proactively identify, and both efficiently and effectively resolve gaps in member quality outcomes and improve financial performance.

Inovalon's advanced analytical capabilities touch approximately 120 million Americans in all 50 states, the District of Columbia, and Puerto Rico – delivering superior insight into clinical and quality outcomes, claims and payment integrity, and financial performance improvement solutions. Leveraging the analysis of more than 5.2 billion medical events from more than 77 million unique de-identified individuals, Inovalon's systems enable the near-real-time identification of gaps in care, quality, and financial performance. An additional analytical layer is then able to determine ideal intervention modality, venue, content, and timing for optimal member and provider engagement and gap resolution success. A nationwide infrastructure of clinical call centers, message fulfillment, integrated data platforms, and in-market clinical personnel numbering in the thousands brings to bear an end-to-end capability from analysis to impact – enabling meaningful healthcare improvement.

“Triple-S Salud and American Health Medicare are committed to providing medical excellence through high quality and cost-effective care in Puerto Rico,” said Socorro Rivas-Rodriguez, President and Chief Executive Officer of Triple-S Salud. “This partnership with Inovalon is a key part of our focus on performance initiatives targeting a wide array of goals related to quality, efficiency and affordability of care over the coming years.”

“There are many unique aspects to our member and provider environment in Puerto Rico,” said Susan Rawlings Molina, President and Chief Executive Officer of American Health Medicare. “Our ability to have timely insight into our clinical outcomes, utilization, and risk scores is seen as a significant benefit in being a healthcare leader in Puerto Rico. Inovalon's ability to not only provide these insights, but also partner in delivering powerful interventions to aid our members and physicians makes them a welcomed addition to our team.”

“The pressure on health plans to deliver high quality of care and a concurrently strong financial performance is growing ever-more prevalent in today’s reform environment,” said Keith Dunleavy, M.D., President and Chief Executive Officer of Inovalon. “We have been impressed by the thoughtfulness and attention to these issues at Triple-S Salud and American Health Medicare. It is a privilege to be working with a health plan that has such a focus on partnership and dedication to the innovative improvement of health services within their community.”

About the Solutions

  • Star Advantage™ enables health plans to both better understand and meaningfully improve their CMS Five-Star Quality Ratings by leveraging the nation’s most widely used healthcare quality measurement system, large-scale healthcare dataset analytics, and a nationwide clinical operations infrastructure designed to provide deep, dynamically updated insight into clinical quality outcomes and highly sophisticated gap closure capabilities – end-to-end. Informed by Inovalon's Medical Outcomes for Research on Economics and Effectiveness (MORE2) Registry™ which contains more than 5.2 billion medical events from more than 77 million unique de-identified individuals, Star Advantage gives health plans near-real-time insight needed to identify highly specific opportunities for quality improvement; derives detailed intervention planning for each specific member’s needs, history, behavior and current situation; and then brings to bear highly targeted gap-closure operations using Inovalon's national and local clinical resources.

  • Prospective Advantage® combines advanced healthcare data analytics with coordinated patient and provider encounter facilitation and support to deliver an integrated solution for identifying and proactively closing gaps in quality, care, assessment, documentation, and risk score accuracy. Analytics bring meaningful intelligence to all forms of outreach and intervention – from print materials and call center outreach, to web-enabled decision support platforms and wireless tablets for in-home member assessment optimization. Altogether, the highly data-driven approach achieves the “right intervention for the right member, in the right venue, at the right time,” facilitating the realization of highly efficient impact.

  • INDICES™ Reporting and Business Intelligence platform leverages OLAP cube technology and customized pre-calculated analytics to enable healthcare organizations near-real-time insight into member, provider, and clinical facility care, utilization, quality, disease, demographic, risk score and financial trends and performance. INDICES brings further value by providing comparative insight against over 77 million patients – enabling users to not only gain deep insight into their own performance with industry-leading detail, but also against highly relevant comparatives otherwise unmatched in the marketplace

About Triple-S Management Corporation

Triple-S Management Corporation (NYSE: GTS) is an independent licensee of the Blue Cross Blue Shield Association. It is the leading player in the managed care industry in Puerto Rico. Triple-S Management also has the exclusive right to use the Blue Cross Blue Shield name and mark throughout Puerto Rico and the U.S. Virgin Islands. With more than 50 years of experience in the industry, Triple-S Management offers a broad portfolio of managed care and related products in the Commercial and Medicare Advantage markets under the Blue Cross Blue Shield brand through its subsidiary Triple-S Salud, Inc. and effective February 2011, also offers non-branded Medicare products through American Health Inc. In addition to its managed care business, Triple-S Management provides non-Blue Cross Blue Shield branded life and property and casualty insurance in Puerto Rico.

About Inovalon, Inc.

Inovalon, Inc., is a leading technology-enabled healthcare solutions provider focused on the importance of healthcare data and its ability to drive dramatic, objective improvement in clinical and quality outcomes, care management and financial performance throughout the healthcare community. Proprietary healthcare datasets, aggregation and analysis capabilities, combined with a national infrastructure of leading-edge technology, clinical prowess and deep human resources, empower Inovalon's advanced generation of healthcare assessment and improvement through highly informed solutions. Driven by a mission to improve today’s healthcare landscape, the employees of Inovalon proudly apply care, ingenuity and dedication to delivering a new approach to healthcare touching more than 100 million Americans – one driven by data and insight – one resulting in meaningful action. Please visit www.inovalon.com for more information.

*Previously released under MedAssurant, Inc. Inovalon is the new name of MedAssurant.

Contacts:

Jason Rose
Inovalon, Inc.
Phone: 301-809-4000
jrose@inovalon.com

Nicole Cohen
Feinstein Kean Healthcare, on behalf of Inovalon, Inc.
Phone: 202-729-4217
nicole.cohen@fkhealth.com