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Inovalon Payer Solutions

Power smarter, faster decisions with analytics-driven payer solutions.

Healthcare Payer Solutions

Our solutions deliver clear, member-centric data analytics to help health plans measure, manage, and improve healthcare outcomes, economics, and quality of care.

Products

Improve quality measurement, risk score accuracy, member and provider engagement, member outcomes, operational transparency, and economic performance – all with one comprehensive suite of software solutions.

Quality Measurement

Healthcare payer solutions for quality measurement providing the market’s leading HEDIS® certified engine for CMS, NCQA, and state data submissions.

Converged Quality

Quality measurement software that empowers your team to feel confident and in control of their quality ratings.

Converged Outreach

See all your intervention activities and vendors together in one place, to make sure members get the right interaction at the right time.

Converged Provider Enablement

Take the complexity out of value-based care, and the friction out of provider relationships, by aligning health plans and providers.

Converged Analytics Benchmarking

Track how you’re trending and see how you compare to industry averages, so you can make smarter, faster decisions.

Risk Score Accuracy

Prospective and retrospective gap identification solutions to help improve risk score accuracy and documentation.

Converged Risk

Take charge of your risk adjustment program and leave audit worries in the rear-view mirror with this risk score accuracy software.

Converged Submissions

Eliminate the headache from the last mile of risk adjustment data and encounter submissions, and deliver complete, accurate, and secure submissions - on time.

Converged Risk Surveillance Analytics

Gain a better line of sight into your risk adjustment programs and stay audit ready as the regulatory landscape changes.

Inovalon Healthcare Data Lake

Gain a single source of truth to store, enrich, and analyze your data.

Converged Outreach

See all your intervention activities and vendors together in one place, to make sure members get the right interaction at the right time.

Converged Patient Assessment

Help provider partners improve your health plan's risk score accuracy without disrupting their day job, with this point-of-care solution for clinical documentation.

Member Outreach

Make member outreach easier and more patient-centric with healthcare payer solutions that integrate with your quality and risk programs.

Converged Outreach

See all your intervention activities and vendors together in one place, to make sure members get the right interaction at the right time.

Converged Patient Assessment

Help provider partners improve your health plan's risk score accuracy without disrupting their day job, with this point-of-care solution for clinical documentation.

Converged Provider Enablement

Take the complexity out of value-based care, and the friction out of provider relationships, by aligning health plans and providers.

Electronic Record On Demand

Cut the complexity out of medical record retrieval by accessing records rapidly, securely, and cost-effectively.

Value-Based Care Management

Improve your value-based care programs and engage provider partners with software that brings quality, risk, and custom program metrics into one place.

Converged Provider Enablement

Take the complexity out of value-based care, and the friction out of provider relationships, by aligning health plans and providers.

Inovalon Healthcare Data Lake

Gain a single source of truth to store, enrich, and analyze your data.

Converged Patient Assessment

Help provider partners improve your health plan's risk score accuracy without disrupting their day job, with this point-of-care solution for clinical documentation.

Industry-Leading Payer Solutions

Our software transforms traditional workflows into data-driven processes to support your health plan’s key objectives. Built with extensive analytics and 25 years of NCQA HEDIS measure certification,¹ our healthcare payer solutions deliver member-centric insights with the speed, accuracy, and flexibility needed to stay ahead.

Our payer solutions are used by 15 of the top 15 U.S. health plans.²

An angled view of a desktop computer displaying a dashboard with various charts, graphs, and data visualizations on the screen, set against a plain white background.

Converged Quality

Get quality scores you can trust from the market’s leading HEDIS^® certified engine for CMS, NCQA, and state data submissions.

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A desktop monitor displaying a data dashboard with charts and a table showing various categories and numerical values, viewed from an angle against a white background.

Converged Risk

Achieve compliance with advanced analytics and flexible member engagement solutions that enable efficient and accurate documentation of member conditions.

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Converged Provider Enablement

Translate organizational goals to the provider point of care with shared insights into patient care quality, documentation, program performance, utilization metrics, and custom initiatives.

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A modern desktop computer displaying a website with navigation links and illustrations of people working, set against a plain white background. The screen shows a clean, professional user interface.

Converged Outreach

Create integrated, member-specific intervention programs and coordinate multiple member outreaches in one efficient SaaS solution for optimal engagement and impact.

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Frequently Asked Questions

What are Inovalon's Payer Solutions?

Our Payer Solutions are our suite of software created specifically for health plans. These solutions turn disconnected payer workflows into data-driven processes that support key goals like improving outcomes across quality measurement, risk score accuracy, value-based care, custom initiatives, and more.

What is the advantage of using integrated data analytics solutions?

Integrated analytics allow health plans to accomplish more in their day, with greater accuracy and speed. Across quality measurement, risk score accuracy, value-based care, and more, our real-time connectivity delivers the data you need to make more informed decisions for better healthcare outcomes and economics. Additionally, our healthcare payer solutions have the flexibility to adapt to your changing business needs.

Can your Payer Solutions integrate with other systems?

Yes, they can! Our solutions are built with a modular approach to enhance the data analytics, reporting capabilities, and workflows you already have in place so you can achieve better results without overhauling what is already working for you. We provide flexibility, scale, and modularity to adapt to your changing business needs.

What does the implementation process involve?

We are eager to begin implementing your new solutions. Throughout this process, we will work closely with you to get your solution up and running. Our dedicated implementation team is fully prepared to launch your solutions once they receive the necessary data and information. The implementation time varies by product and the internal preparation time that your organization needs.

¹ "Inovalon’s Converged Quality Achieves 25th Consecutive NCQA HEDIS® Certification," Inovalon, July 31, 2025.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
²Top 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.

TESTIMONIALS

Real Results, Real Voices

Discover the Inovalon difference.

“

The customer service is really top notch. Inovalon sees the needs of the customers – really sees what we need to deliver and understands the landscape changes in the government and regulatory environment, and then improves their products so we’re able to continue to deliver year over year.
Gabe MedleyVice President, Risk Adjustment, Quality, and Analytics, Blue Cross Blue Shield Michigan

“

Inovalon listened to us and they knew what we needed. They heard our requirements and they made sure that they met them and made sure that we were happy and getting what we asked for.
Brenda WolfordBusiness Analyst, Geisinger Health Plan