4 ways health plans are improving metrics using analytics within Inovalon’s Payer Solutions
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For national and regional health plans, data is at the center of a robust growth and performance strategy. Vast amounts of healthcare data can help inform quality performance, risk score accuracy, population health initiatives, and more. Meanwhile, internal data analyses further ensure plans are improving metrics using payer analytics by tracking their results over time and against competing plans.
Inovalon’s Payer Solutions unite quality, risk, and engagement solutions into one data-driven platform, so plans can act earlier, submit with confidence, and improve performance. This blog explains what payer analytics in healthcare means and four key areas that analytics help plans improve across quality measurement, risk adjustment, population health, and member outcomes.
What we’ll cover:
- What payer analytics is in healthcare and how health plans use data analytics to measure quality, cost, and outcomes.
- How payer analytics can help improve Medicare Advantage Star Ratings, including forecasting, measure-level visibility, and closing gaps that impact performance.
- Four practical ways health plans apply payer analytics dashboards to improve metrics: clinical quality performance, risk adjustment documentation, health equity benchmarking, and patient outcomes.
- How payer analytics support faster action through benchmarking, member-level insights, and targeted outreach to drive measurable improvement.
Payer analytics in healthcare
Payer analytics is the use of healthcare data – such as medical and pharmacy claims, clinical records, and supplemental files – to help health plans measure and improve performance across quality, risk, and value-based care. By turning data into dashboards and member-level insights, payer analytics help plans forecast performance, identify care and documentation gaps, prioritize outreach, and track improvement over time at the contract, provider, and member level.
Here are four key benefits of Inovalon’s payer analytics capabilities.
1. Improve clinical quality performance
Health plans trust our quality performance dashboards to help forecast measure rates and results, set performance benchmarks, track medical record progression, and tailor outreach strategies. This is all powered by industry leading software analyzes healthcare performance on over 205 million lives each year for state and federal quality measurement, representing over 60% of the entire U.S. population.1
Star Rating forecast
This dashboard provides a comprehensive, at-a-glance view of a Medicare Advantage plan’s Star Ratings, with detail on their overall performance, Part D and Part C performance, and quality improvement performance.
It breaks down every key element that goes into Star Ratings and allows a plan to see their performance over time, so they can easily understand how they’ve improved, or perhaps fallen short, against previous years. This view also identifies the various data sources that contribute to the forecasts and clearly notes any areas that have seen a decline.
Informed by this data, MA plans can better focus their resources on areas of low performance, while maintaining their desired ratings to remain a leader against other plans.
Benchmarking and population rate reporting
The Population Rate Report within Inovalon’s Converged Quality™ breaks down a health plan’s population by those eligible for a specific measure, those compliant, those non-compliant, and any contradictions in the data. This is summarized by a performance rate which gives an overall indication of how well a plan is doing on a per-measure basis.
The dashboard essentially serves as a performance GPS, guiding the plan on what to do next to improve their members’ population health. It eliminates the time that would otherwise be spent collecting and analyzing this data, delivering greater speed to action – with more focused efforts.
Medical record progression tracking
This dashboard helps health plans improve their metrics by providing insight into the progress of a plan’s medical record retrieval project.
The dashboard delivers population-level performance and comprehensive member-level performance details. The overall view shows the population’s total compliance status against member status and measure rate progression overtime. At the member-level, plans can see the finer details they need, including a list of each member by name, measure keys, status, compliance, and more – all without having to do further analysis.
Both views enable faster, more informed decision making at scale. Health plans are better able to focus on specific member needs and effectively track how those individual interactions enhance their overall performance.
2. Improve risk adjustment documentation and RADV readiness
Inovalon’s Converged Risk™ empowers health plans with member insights to improve overall health outcomes and risk score accuracy. This software offers risk models for all plans – CMS-HCC for Medicare Advantage plans, HSS-HCC for commercial ACA plans, and state-specific models for Managed Medicaid plans, including CDPS, Rx, CRG, and ACG – to ensure accurate documentation of member chronic conditions.
The payer analytics within Converged Risk also include RADV audit analytics and SDOH detail, delivering an in-depth view of member populations so plans can better meet their internal goals and maximize targeting efficiency.
Users can easily identify, stratify, score, and prioritize members on a wide array of disease processes before they become apparent through traditional diagnostic codes. This means plans can better target patient risk at an earlier stage, improving member care outcomes and their healthcare resource utilization.
This is all made possible by:
- Diverse data sources, including medical, pharmacy, utilization history, associated medical conditions, use of DME, testing patterns and results, procedure history (CPT/HCPCS, DRG, etc.), member-reported information, SDOH, diagnoses codes from claims, and supplemental data
- Comprehensive gap identification and compliance, including year-over-year previously coded conditions, under-coded and suspected conditions that were not previously coded, and over-coded conditions lacking appropriate clinical evidence
- Intelligent targeting that is calibrated to the appropriate clinical evidence and aligns to the selected intervention type
Together, these analytics ensure accurate documentation at scale, with the flexibility and expertise health plans need to understand gaps, assess financial impact, be prepared for compliance changes, and best prioritize member needs.
3. Health equity benchmarking
As health plans continue to use analytics to improve performance across quality and risk initiatives and member health outcomes, new performance programs and regulation changes continue to influence what payers are measuring and where they’re focusing resources.
For example, with the new Excellent Health Outcomes for All (EHO4all), MA plans will need to add a new component to their analytics efforts: benchmarking their advancements in member health equity against other MA plans.
With Inovalon’s Converged Stars Health Outcomes™, plans gain organizational and contract-level performance on EHO4all summary scores and on individual quality measures. Users can stratify their scores by specific social risk factors to clearly understand the largest disparity gaps within their member populations and the SDOH factors related to those gaps.
4. Align payers and providers to improve patient outcomes
Just as health plans must use analytics to improve their performance metrics, they also have a responsibility to align their performance initiatives with their provider networks.
Inovalon’s Converged Provider Enablement™ empowers plans and providers to better collaborate on value-based efforts and custom initiatives, increasing their alignment on expectations, quality performance goals, and patient care investments. This is made possible by timely, robust data that delivers extensive patient profile details for plans and providers to utilize, reducing the complexity of care coordination and contract management.
Patient profile overview
This dashboard delivers real-time performance data at the patient level. It sets the patient-provider encounter up for success with valuable insights that detail patient health history and opportunities to improve their quality of care. This enables providers to take immediate action and better coach patients on the unique care they need, which can impact overall population outcomes.
The dashboard includes details such as a patient’s PCP history, uncoded conditions, suspected conditions, and coded conditions – with quality outcomes information on potential gaps, what the patient is eligible for, and what they have been adherent with.
Overall program summary
This dashboard gives plans clarity to their value-based arrangements and custom strategic initiatives, and it gives providers the opportunity to meet contract expectations. The payer analytics align reporting between the two parties on care and documentational gaps, while improving the care experience by delivering timely, comprehensive, and patient-specific data to providers to inform their care strategies.
With this view, payers can see their total programs, the program measures, patients in the program, and how the program is performing on quality outcomes and medical coding. Items at risk are clearly displayed in red to quickly bring focus to care gaps and open opportunities. This streamlines management of all initiatives – across standard federal and state-level initiatives to full customized goals – with a single solution.
Customized reporting for priority initiatives
Perhaps the best views within Converged Provider Enablement are those that health plans make for their unique priorities.
Our custom analytics capabilities allow health plans and their provider partners to launch initiatives based on the needs of their membership and sub-populations. These configurable dashboards can help highlight efforts on obesity, smoking cessation management, surgical outcomes, provider specialty performance, and more.
Powered by our industry-leading analytical design and execution capabilities, health plans can improve metrics using analytics at a detail that is unlike any other available in the market – and at a better method than a costly DIY approach.
Frequently asked questions on payer analytics in healthcare
What are payer analytics in healthcare?
Health plans use payer analytics to analyze member and provider data to measure plan performance, identify care and documentation gaps, and improve quality, cost, and outcomes.
- Health plans use payer analytics dashboards to turn raw data into performance insights across quality, risk, and care management programs.
- Healthcare payer analytics also support population health analytics by helping plans segment member groups and prioritize interventions at scale.
How do payer analytics help improve Medicare Advantage Star Ratings?
Payer analytics help improve health plan Star Ratings by giving plans a tool to forecast measure performance, pinpoint the measures driving Star Ratings changes, identify member-level gaps, and target outreach and interventions that improve quality and adherence outcomes tied to quality measures.
Inovalon’s Payer Solutions help plans track results over time, focus on low-performing measures, and align outreach to close gaps that impact Medicare Advantage Star Ratings. With quality performance analytics, plans can benchmark against prior years and identify where performance is trending before reporting cycles close.
How do payer analytics help health plans improve clinical quality performance?
Payer analytics help improve clinical quality performance by enabling health plans to forecast measure rates, benchmark performance, track medical record progression, and focus outreach strategies on the members and measures most likely to impact quality results.
Quality measurement analytics support HEDIS®/NCQA-aligned reporting by highlighting eligible, compliant, and non-compliant populations for faster action.
Clinical quality dashboards reduce manual analysis by surfacing member-level care gaps and tracking progress throughout the measurement year.
How do Inovalon’s payer analytics support risk adjustment accuracy and documentation?
Inovalon’s payer analytics support risk adjustment by helping plans identify suspected, under-coded, and previously coded conditions, and improve documentation completeness across risk models.
RADV audit analytics and documentation gap insights improve preparedness by showing where coding support is needed to strengthen compliance and reduce audit risk.
Improve your performance metrics with payer analytics from Inovalon
Serving all 15 of the top 15 U.S. health plans2, our payer analytics are driving performance improvements, better care outcomes, and lower healthcare costs every day.
Contact our team to discover how our Payer Solutions can help advance your performance on quality reporting, risk score accuracy documentation, health equity, and more.
Sources:
1 Inovalon internal reporting, July 2025. Based on Measure Year 2024 population counts and U.S. Census Data as of December 2024 – https://www.census.gov/data/tables/time-series/demo/popest/2020s-national-total.html
2 Top 15 health plans based on AIS List of Top U.S. Payers, Sept. 2025. Inovalon internal reporting based on Q2 2025 enrollment data, October 2025.
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