Converged solution suite: Healthcare payer solutions in one platform

The demands on managed care plans seem to increase each year. Between navigating government policy and regulatory reporting requirements, managing member outcomes, monitoring competitors’ performance, and continuing to push the needle for health equity, there is a never-ending list of things to do – which is why SaaS-based healthcare payer solutions are so important.

Data-driven workflows empower health plans across the nation to achieve more in their day while progressing key initiatives faster to improve clinical results and healthcare economics.

The following explores how the right software can make all the difference for health plans.

Benefits of healthcare payer solutions

Payer technology solutions can transform how a health plan works. With SaaS-based workflows, staff have more information at their fingertips to operate with greater efficiency and accuracy, which increases the impact they can have on members.

Integrated payer solutions can simplify the traditional, siloed methods that have traditionally bogged down health plan operations, helping them do more with their time and data.

Healthcare payer solutions help plans:

• • Grow and scale their operations faster and easier with a cloud-based foundation
  • Make more informed decisions with a greater amount of data – and make fewer human errors in collecting and analyzing data
  • Improve member outcomes
  • Increase provider engagement
  • Achieve all the above with a cost-effective approach

Payer quality and risk solutions

While many plans are already using healthcare payer solutions, only few have figured out the key to getting the most out of their software: Making sure their solutions work well together. Too often, quality measurement and risk score accuracy teams are focused on their own initiatives, when in reality, they are both trying to achieve similar outcomes.

That was the foundation for Inovalon’s Converged solutions. We’ve brought capabilities to support key health plan programs – such as quality measurement, risk adjustment, and value-based care initiatives – into one suite of products and add-ons that deliver member-centric insights and actions to help health plans measure, manage, and improve healthcare outcomes, economics, and quality of care. Converged products are powered by the Inovalon ONE® Platform, the solution of choice for 23 of the top 25¹ U.S. health plans.

Converged Quality

Converged Quality is an industry-leading HEDIS®-certified engine for CMS, NCQA, and state quality measure submissions. This payer solution analyzes healthcare performance on 80% of all NCQA-covered lives each year², helping plans achieve Star Ratings performance that exceeds the industry average year-over-year.

How are plans who leverage this solution able to accomplish this? With an engine that delivers:

• • Deeper member insights, with predictive analytics and benchmarking to better understand which members should be engaged and when, and transparency into measure rate results.
  • Greater program flexibility, with year-round prospective gap closure and the option for complex custom measure creation to better fulfill all your quality program goals.
  • Industry-leading expertise and support that help drive efficiencies in quality operations and initiatives.

Converged Quality is the comprehensive, end-to-end solution that makes it easy to meet all quality measurement, reporting, and improvement needs.

Converged Risk

Converged Risk powers prospective and retrospective gap identification to improve a health plan’s risk score accuracy and documentation. This software makes risk score accuracy easier, faster, and more efficient.

This is the new generation of risk score accuracy. Our software allows health plans to:

• • Get smarter analytics. Informed by the industry’s largest primary source dataset and combined with multi-faceted modeling and compliant gap identification and targeting, our analytics are unmatched. Health plans leveraging this solution can see persistent, suspected, and potentially over-coded risk gaps in one location.
  • Access data insights more easily. Converged Risk delivers full program transparency, with analytics tailored to specific goals and the ability to control targeting by specific conditions and members.
  • Run faster risk score analytics. Data loads are quick, with short analytics runs and on-demand gap refreshes available as frequently as needed.

When operating together, Converged Quality and Converged Risk deliver enhanced efficiency. The solutions give health plans the ability to address gaps for quality, risk, utilization, and custom initiatives in a single, coordinated outreach that eliminates redundant member and provider engagement activities, and reduces health plan costs – all while driving greater overall performance improvements.

Payer data, outreach, and social determinants of health solutions

Building on the power of Converged Quality and Converged Risk, our solution suite offers additional modules to further drive health plan success.

Converged Provider Enablement

As much as health plans can improve their operations and analytics, the best member outcomes occur when provider networks are aligned and engaged.

That’s why we built Converged Provider Enablement, which provides deep insights into performance metrics for quality, risk score accuracy, and health plan custom measures and metrics. This allows both plans and providers to understand and track performance against targets such as value based contracting and other cost and care management initiatives. The solution delivers 24/7 access to timely patient data via easy-to-use dashboards with simple data integration and accurate analytics, all available via single-sign-on.

Converged Outreach

Building on the data insights available within Converged Provider Enablement, Converged Outreach drives member-centric intervention planning and integration for quality improvement, risk score accuracy, and customized initiatives​.

Converged Outreach makes it easy to create integrated, member-specific intervention programs and coordinate multiple member outreaches in one efficient, SaaS solution for optimal engagement and impact. It enables personalized intervention plans for members across quality, risk, and value-based care needs, using advanced analytics built with feedback loops for effective member prioritization.

Healthcare Data Lake

This healthcare payer solution enables transformational care by delivering deep data insights throughout a health plan, informing various teams with timely, purpose-built custom dashboards.

Healthcare Data Lake provides comprehensive data access in near real-time, to help improve quality outcomes, better manage population health, enhance provider performance, and drive risk score accuracy.

Health Equity Index Dashboard

With the new CMS Health Equity Index recently introduced, this healthcare payer solution gives Medicare Advantage (MA) plans a tool to understand how their organization will perform and benchmark against other plans.

Health Equity Index Dashboard provides visibility to MA plan- and contract-level performance, with the ability to characterize data by population demographic, clinical, and socioeconomic profiles. Plans can identify the largest disparity gaps within the framework of the CMS Health Equity Index component measures to better address health disparities at greater speed and accuracy.

Discover the power of Inovalon Converged solutions

Inovalon’s Converged healthcare payer solutions empower plans to work with greater data, speed, and accuracy. Applied across quality, risk, member outreach, provider engagement, and health equity programs, our solutions are here to deliver the data health plans need to take on massive, complex initiatives to improve healthcare outcomes, economics, and care quality.

Realize the value of having advanced data analytics at the helm of your key initiatives. Connect with one of our solution experts to learn more.

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Sources:

¹ Top 25 health plans based on AIS List of Top U.S. Payers, 2022

² Inovalon calculation based on HEDIS® MY2021 data. June 2022.

Inovalon and design^®, Inovalon^®, and the Inovalon ONE® Platform are trademarks of Inovalon, Inc.