Risk Score Accuracy

Ensure compliance and accurate reimbursement with advanced analytics and member engagement solutions enabling efficient, precise documentation.

Powered by the Inovalon ONE® Platform

Over 15 years of risk adjustment experience and expertise empowering Medicare, Medicaid, and Commercial plans to achieve superior accuracy and performance.

Overview

Inovalon delivers a scalable, end-to-end risk score accuracy solution that can be tailored to meet your unique needs. We work with you to ensure the accuracy of your members’ risk scores to drive overall program success.

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Retrospective Gap Identification

Identify, pursue, and document valid member diagnoses via EHR interoperability, clinical data extraction, or paper-based retrieval.

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Predictive Analytic Insights

Create cohorts and run predictive gap identification and intervention planning analytics on-demand to identify and address emerging and suspected member diagnoses.

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Data-Driven Intervention Planning and Execution

Implement proven education and multi-channel intervention strategies to support a more comprehensive assessment and accurate disease burden documentation.

Benefits

Drive risk score accuracy with machine learning-trained analytics that leverage historical data, trends, and past performance to identify member diagnoses that may be incompletely or improperly reflected within claims data and medical records.

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Unparalleled Data Assets and Analytics

Gain insights informed by data for more than 348 million patients, enabling effective documentation gap closure and informed strategic decision making.

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In-Office Clinical Documentation Support

Leverage our compliant clinical documentation support tool, ePASS®, to deliver claims history and member gaps at the point of care to improve disease documentation and risk score accuracy.

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Seamless Member Experiences

Access deep member insights to drive highly-targeted, tailored interventions that offer members flexibility and choice to select the right encounter venue for them.

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Regulatory and Compliance Expertise

Inovalon has over 15 years of policy, regulatory compliance, and clinical experience to deliver expert program oversight and ensure compliant program execution.

How it Works

Ensure compliant, accurate documentation of member conditions and achieve your performance goals with a comprehensive, end-to-end solution or one tailored to supplement your current program.

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Drive risk score accuracy with sophisticated analytics, nationwide connectivity, and effective member and provider engagement strategies

Up to half of a health plan’s reimbursement is determined by the health status of its membership. Disease documentation, coding accuracy, and compliance are key to making health plans successful. Inovalon’s risk score accuracy solution leverages advanced analytics, nationwide provider site connectivity, and a suite of proven engagement tools to improve performance.

    • Identify, pursue, and document valid diagnoses via EHR interoperability or clinical data extraction, as well as traditional paper-based medical record retrieval.
    • Customize target hierarchical condition categories based on unique membership characteristics and data elements.
    • Predict emerging patient-specific diagnoses and drive highly targeted, patient-centric interventions.

Inovalon Converged Risk Analytics

Achieve Greater Insight, Efficiency, and Satisfaction with An Integrated Program

Even the strongest quality program is limited when siloed from the health plan’s risk score accuracy initiatives.

Inovalon Converged Risk Analytics is the industry’s first and only solution that improves the quality of care for members and supports risk score accuracy for health plans. This integrated solution improves insight into member gaps in care and documentation – delivering a complete member view that enables greater care coordination and more comprehensive care encounters.

The results: improved member health outcomes, reduced member and provider abrasion, and greater operational efficiency and performance.

Read the press release for more information.

Resources

Payer Resources

Gain insights from Inovalon case studies, infographics, videos, and other resources to get the most out of our products and solutions.

Let’s transform healthcare together.

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Questions? Call (301) 809-4000

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