Better Data, Better Care: Improving Payer-Provider Collaboration

In value-based care, shared goals between health plans and providers are only possible when both parties are working from the same playbook. But in reality, providers are often left to guess at the full picture. Many don’t have access to their patient’s complete medical history, especially those not using large EHR systems. That lack of visibility can mean missed care gaps, delayed diagnoses, and extra administrative burden for both the provider and the health plan. 

To move value-based care forward, transparency isn’t optional, it’s essential. 

The problem: fragmented data, fragmented care 

Providers are being asked to do more with less time. Between documentation requirements, care coordination, and quality tracking, they’re often stuck navigating disconnected data sources just to understand a patient’s full health status. 

When providers can’t see a patient’s complete history (past diagnoses, procedures, chronic conditions, or medications) they risk missing key quality care gaps or risk recapture opportunities. That means either the health plan has to follow up with additional interventions or the issue goes unresolved until the patient returns, delaying care and hurting value-based care outcomes. 

The solution: a shared, centralized view 

That’s why we built the Patient Profile and the 360 Patient Profile features in Inovalon’s Converged Provider Enablement^TM, to support payer provider collaboration with a shared, transparent foundation for value-based care. 

With Patient Profile, health plans get a centralized, easily accessible view of quality outcomes, medical history – including any medications, diagnoses, and procedures – and medical coding.  

360 Patient Profile provides even more granular detail for providers. While Patient Profile only includes a health plan’s own data, 360 Patient Profile includes all of a patient’s history as pulled from Inovalon’s full data repository. This gives providers an even wider range of data points:  

• Patient demographics 
• Provider demographics 
• Quality outcomes 
• Value-based care program 
• Custom member cohort 
• Medical coding 
• Medical history 
• Surgical history 
• Hospitalizations, emergency visits, and inpatient and outpatient care 
• Allergies 
• Immunization history 
• Family medical history 
• Medications 
• Lifestyle and health habits 
• Diagnostic testing results 
• Member care journey timeline 
• Previous practitioners 
• Social drivers of health 

This single, unified view brings clarity to the point of care, helping providers document appropriately and confidently close gaps in one visit. 

What it means for health plans 

For health plans, Patient Profile enhances the way you support provider partners. By supplementing value-based care program data with complete patient health insights, you make it easier for providers to take immediate action. This builds trust, strengthens payer provider collaboration, and drives measurable improvements in value-based care program performance, risk adjustment and quality outcomes, and population health. 

What it means for providers 

For providers, the 360 Patient Profile delivers clarity where it’s most needed: in the exam room. With a full view of the patient’s health data, they can understand the patient’s complete medical story, reduce missed opportunities and follow-up burdens, and deliver a better, more efficient patient experience.  

A smarter way forward in value-based care 

When health plans and providers collaborate and operate with transparency, everyone wins — especially the patient. The Patient Profile and 360 Patient Profile features are more than data-sharing tools; they’re strategic enablers that align priorities, reduce friction, and makes whole-person care a reality. 

By putting the full picture in front of those delivering care, we’re helping both plans and providers take the next step in value-based care together. See how it works. 

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