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To succeed in today’s increasingly data-driven healthcare landscape, healthcare payers need advanced analytics and actionable insights to improve member health outcomes. Leveraging our nation-wide connectivity and data-driven analytics, Inovalon analyzes and delivers insights to improve quality outcomes, risk-score accuracy, operational efficiencies, business intelligence and economic performance for health plans across the country, including all 25 of the top 25 U.S. health plans.

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Quality Measurement, Reporting & Improvement
Quality Measurement, Reporting & Improvement
Point-of-Care Solutions
Point-of-Care Solutions
Risk Score Accuracy Improvement & Submissions
Risk Score Accuracy Improvement & Submissions
Value-Based Contract Management
Value-Based Contract Management
Strategic Advisory Services
Strategic Advisory Services
Clinical Data Extraction
Clinical Data Extraction
AI Icon
Artificial Intelligence
Telehealth
Virtual Health Visits
Cloud-Based Healthcare Data Lake
Cloud-Based Healthcare Data Lake
Population Health Insights
Population Health Insights
DataStream API Marketplace™
DataStream API Marketplace™
Consumer Health Gateway
Consumer Health Gateway

Quality Measurement, Reporting & Improvement

An effective quality improvement program demands a coordinated and comprehensive approach—one that empowers you to succeed in today’s increasingly data-driven healthcare ecosystem. Behind the strength of our massive data breadth, advanced predictive and comparative analytics, cut-point forecasting and benchmarking capabilities, and point-of-care intervention toolsets, we put your data to work.

Inovalon leverages an integrated, modular approach to help health plans and provider systems participating in federal, state and accredited quality measurement programs succeed in today’s data-driven healthcare atmosphere. With two decades of proven success, Inovalon’s platform provides clinical and quality outcomes measurement analytics to more than 80% of the nation’s healthcare organizations, delivering up to 15 times faster processing speeds to drive improved quality performance.

Our quality solution delivers deep, highly sophisticated patient-level strategic insights and analytically driven engagement capabilities necessary to achieve meaningful clinical quality performance improvements within an ongoing date-of-service period. Our seamlessly integrated capabilities provide the right tools for quality improvement to impact health outcomes meaningfully, achieve performance incentives, and drive improved financial performance. Health plans partnering with Inovalon for their quality improvement initiatives achieve an average one-half Star performance improvement on a year-over-year basis. Providing actionable insight into where you stand compared to the rest of the market and the capabilities to improve upon results, Inovalon’s platform empowers organizations to focus resources on the right areas and achieve their precise quality improvement performance goals.

Learn more about Quality Measurement, Reporting & Improvement.

Quality Measurement, Reporting & Improvement

Point-of-Care Solutions

For over a decade, Inovalon has been an industry leader in quality improvement and risk score accuracy, with a suite of member engagement and point-of-care (POC) solutions flexibly designed to be deployed either as an integrated end-to-end solution or as a standalone program.

Offering your members convenience and flexibility of choice, Inovalon’s NCQA- and CMS-compliant POC solutions proactively connect members with providers to achieve meaningful improvement in quality, risk score accuracy, utilization and care management. Inovalon’s Platform empowers more than 2,500 nationally recognized retail clinic partners and certified nurse practitioners (NPs) to deliver value above and beyond the EMR/EHR. Inovalon’s quality and risk-focused analytical insight delivers data to empower each face-to-face encounter for improved assessment and documentation accuracy.

Learn more about Point-of-Care Solutions.

Point-of-Care Solutions

Risk Score Accuracy Improvement & Submissions

Up to half of a health plan’s revenue is determined by the health status of its membership — as reflected in claims and supplemental data submissions — and up to 10% of a member’s final risk score can be derived from a health plan’s risk adjustment program. With so much at stake, Inovalon’s industry-leading capabilities empower our customers’ success by leveraging our real-world proprietary dataset, containing data from more than 338 million patients and 63 billion medical events, advanced analytics, extensive connectivity, and powerful point-of-care solutions and in-office support tools to identify and predict patient gaps and improve disease documentation and accuracy.

Powered by the Inovalon ONE® Platform, Inovalon delivers the industry’s most advanced suite of data-driven solutions that drive risk adjustment accuracy and compliant claims submissions, delivering an average 98.9% acceptance rate across RAPS, EDS and EDGE Server submissions.

Learn more about Risk Score Accuracy Improvement & Submissions solutions.

Risk Score Accuracy Improvement & Submissions

Value-Based Contract Management

Achieve Transparency & Actionable Insights to Improve Patient Outcomes & Value-Based Contract Performance with Inovalon ValueCompass™

With an aim of moving toward a more value-driven healthcare delivery system, payers and providers are working more collaboratively in value-based arrangements to empower data-driven patient care and focus on improving clinical quality and economics of healthcare.

With this collaboration, payers and providers face ongoing challenges managing value-based contracts, often including a lack of real-time connectivity, data sharing capabilities and analytics that can impact patient care and the payer-provider relationship—a cornerstone of value-based care success.

A value-based contract management solution that strengthens the payer and provider relationship

The success of value-based arrangements is predicated on payers having access to data and the ability to share the derived insights that target patient care needs and provider performance with their contract stakeholders in real time.

ValueCompass is a streamlined, cost-effective cloud-based solution that reduces the complexity of managing value-based contracts with greater efficiency. With ValueCompass, payers can more effectively manage their value-based care initiatives while improving provider transparency ensuring greater continuity of care through a simple, user-friendly portal based on their patients’ care needs.

ValueCompass improves time and cost efficiency and reduces administrative oversight with interactive dashboards that support:

Improved transparency and alignment: Share with providers the value-based contract performance at the patient and measure levels and engage providers to close gaps in care.
Streamlined contract management: Reduce manual errors and administrative costs by providing self-service configuration tools, configurable patient attribution and provider hierarchy settings.
Accelerated implementation: Rapidly deliver value-based care measure metrics to providers with easy data integration, patient attribution and provider hierarchy configuration, and single-sign-on capabilities.

Learn more about Inovalon ValueCompass™.

Value-Based Contract Management

Strategic Advisory Services

We know payers. From optimizing networks to improving Star ratings to refining care plans, Avalere, an Inovalon company, leverages its deep subject matter expertise powered by Inovalon’s innovative technologies and comprehensive datasets to optimize your business practices. Coming from government, patient groups, health plans, pharmaceutical companies, device manufacturers, health IT companies, clinicians and more, Avalere’s experts have dedicated their careers to improving healthcare. Strengthened by large-scale patient data, this substantive, interdisciplinary team contributes perspective and focus to progress practical, data-driven custom solutions. Avalere’s reputation is built on this solid, proven approach.

Learn more about Strategic Advisory Services.

Strategic Advisory Services

Clinical Data Extraction

More than 100 million clinical reviews are performed each year in the United States. For those organizations needing to collect this information, this process has been laborious, has caused friction with provider practice offices, has required significant logistical and operational coordination, has been prone to errors and inconsistency, and has yielded vast amounts of unstructured data—not to mention the associated costs.

Inovalon’s Clinical Data Extraction as a Service (CDEaaS™) streamlines data exchange by leveraging our connectivity with more than 311,000 providers on the Inovalon ONE® Platform today. This autonomous process captures comprehensive, rich critical data for all needs that would benefit from the collection of clinical medical record information—from clinical quality improvement and risk-score accuracy improvement to clinical trial support and pharmacy-related prior authorization data aggregation, all with the concurrent benefits of eliminating provider friction, providing full digital audit support files, dramatically shortening turnaround times and lowering costs by as much as 70% versus traditional labor-based approaches.

Learn more about Clinical Data Extraction.

Automated Medical Record Retrieval & Review

Artificial Intelligence

With one of the industry’s largest, primary-sourced, longitudinally matched datasets, containing more than 338 million unique patients and 63 billion medical events, Inovalon leads the industry in application of data-driven artificial intelligence in healthcare. The diversity of our data combined with continuous data streams that improve data quality allows for the real-time refinement and application of our artificial intelligence solutions, delivering speed to impact and value.

The foundation of our artificial intelligence solutions rests on our unmatched, clinician-to-data-scientist relationship approach and is backed by more than two decades of clinical expertise validating our solutions and end-to-end quality assurance led by our clinical team. Leveraging the compute environment that powers the Inovalon ONE® Platform with the expanding connectivity of the Platform, our artificial intelligence solutions enable real-time access to the right insights at the right time to drive improved patient outcomes and economic performance.

Whether you are seeking to accelerate the clinical record review process, improve risk gap detection rates, better understand and predict adverse patient-specific events, design or enhance a population health management program, or augment hospital census forecasting capabilities, Inovalon has the right artificial intelligence solution to help you reach your goals.

Learn more about Artificial Intelligence Solutions in Healthcare.

Virtual Health Visits

A Telehealth Offering of the Inovalon ONE® Platform

Telehealth, the delivery of healthcare, health education, and health information services via remote technologies, is a rapidly growing segment of the healthcare ecosystem that is of increasing importance to payers, providers, and patients alike.

Telehealth has become a vital tool in enabling the healthcare industry to respond to the unprecedented challenges of COVID-19. It is anticipated that the shift in the patient-provider engagement dynamic to more virtual settings will continue to gain momentum.

With Inovalon’s Virtual Health Visit (VHV) solution, a telehealth service configuration of the Inovalon ONE® Platform, you can engage Medicare Advantage, Commercial ACA and Managed Medicaid members meaningfully and close quality and risk documentation gaps in a single, comprehensive visit delivered virtually in the comfort and safety of a patient’s home.

Virtual Health Visits Offer the Same High Value Our Customers Expect

Inovalon’s VHVs offer the same value and effectiveness of our traditional In-Home Assessment (IHA) solution that so many have come to expect from the Inovalon ONE® Platform:

  • Assessments are completed using Inovalon’s regulatory compliant point-of-care clinical encounter and documentation support tool, ePASS® – the same assessment tool that has been used for In-Home Assessments and Retail Clinic Assessments for more than 10 years
  • Members are engaged in their health and healthcare through the modality that best serves their needs and preferences
  • Health plans realize increased member satisfaction and engagement, as well as improvements in risk score accuracy, operational efficiency, and financial performance

Learn more about Inovalon’s Virtual Health Visit solution.

Virtual Health Visits

Cloud-Based Healthcare Data Lake

The data generated in the healthcare industry increases by 48 percent every year. The amount produced in 2020 alone could exceed 2.3 zettabytes, or 2.3 trillion gigabytes. That’s the amount of data it would take to watch 262 million years straight of HD movies.

This tsunami of data, along with industry inefficiencies, make healthcare ripe for digital innovation that will enable stakeholders to transform the rich amounts of disparate and siloed patient data into insightful and actionable data across the continuum. While the healthcare industry’s technological advances still lag many other industries, Inovalon’s Cloud-Based Healthcare Data Lake closes the gap and helps address the challenges of making “big data” useful and actionable.

Healthcare Data Platform Needs Inovalon’s Data Lake
Accurate & Complete Data Applies 1,100+ data integrity checks, trained from the ingestion of more than 63B medical events within Inovalon’s massive dataset, the MORE2 Registry®
Clinical Data Connectivity & Integration Converts unstructured clinical data from more than 311K clinician EHRs into structured, usable information
Data Enrichment
  • The nation’s largest proprietary healthcare dataset, the MORE2 Registry®
  • Patient social determinants of health indicators
  • Layered predictive cost and utilization risk indicators (e.g., ACG, HCC)
Support for Downstream Use Cases User friendly dashboards, exportable data extracts, APIs and query tools to support improved care delivery, operational efficiency and financial performance initiatives
IT expertise in healthcare data normalization and modeling, as well as quality and risk programs Secure and scalable platform built by healthcare data experts experienced in quality and risk score accuracy program compliance

 

Learn more about Cloud-Based Healthcare Data Lake.

Cloud-Based Healthcare Data Lake

Population Health Insights

The health of a population impacts many aspects of a health plan’s success, including quality outcomes, risk score accuracy, case management and resource allocation. There is a growing consensus that as little as 10% of an individual’s overall health is a result of clinical care — other factors include health behaviors, physical environment, social and economic factors and biology. However, many health plans lack a holistic view of members, data integration from disparate data sources and insight into a population’s social determinants of health (SDOH).

In addition, limited comparative data to evaluate performance against national and regional benchmarks, and limited resources for case management programs and interventions present challenges to population health management.

Inovalon’s Population Health Insights solution addresses these challenges, enabling health plans to identify and assess the needs of various populations to support and inform quality improvement, intervention and case management programs to deliver patient-centered care and reduce total cost of care.

Learn more about Population Health Insights.

Population Health Insights

DataStream API Marketplace™

Accelerating Consumer Access & Payer Compliance Through FHIR®-Enabled Real-Time Clinical Data Exchange

Features and Benefits

  • Select from a menu of API solutions best suited for your business objectives, including curated patient history profiles, AI-driven predictive analytics, care gap analysis, eligibility/EOB insights, and more
  • Empower your existing reporting systems and toolsets with advanced analytics and patient-specific detail pulled from a myriad of data sources, including Inovalon’s MORE2 Registry®
  • Leverage the latest secure data exchange platform to extend the reach of your patient engagement strategies into third-party devices that are used by patients every day
  • Search for and receive normalized clinical and claims data for patients in real-time using a FHIR®-based API Gateway
  • Achieve full compliance with the requirements of the Interoperability Rule
  • Power new healthcare solutions without the need to rip out and replace legacy IT infrastructure

Inovalon DataStream API Marketplace™ enables any authorized third-party platform or application to securely access comprehensive patient-specific data and analytics derivations on-demand, in real time.

Accessible through Fast Healthcare Interoperability Resources (FHIR®) application programming interfaces (APIs), calls to the Inovalon DataStream API Marketplace™ can access Inovalon’s extensive patient profiles, the Inovalon Consumer Health Gateway™, and clinical data accessible through Inovalon’s CDEaaS™ Module – returning deep, longitudinally linked data and insights on demand in real time.

Power your healthcare applications with comprehensive, data-informed APIs

Imagine new possibilities for delivering extraordinary patient experiences, improving workflows through seamless integration, and enhancing operational efficiency through the Inovalon DataStream API Marketplace™. With FHIR®-enabled, real-time clinical data exchange, configurable patient authentication toolsets, and easy to deploy interfaces, highly specific patient encounters and experiences are consumable on demand.

Empowered by 20+ years of experience providing data-driven analytics and technologies, broad connectivity, deep data assets, and a secure and compliant infrastructure, the Inovalon DataStream API Marketplace™ delivers targeted and bundled API results that enable interconnectivity across the healthcare ecosystem at scale to drive unparalleled impact at the point of care.

Learn more about Inovalon DataStream API Marketplace™.

1 In partnership with Carequality
DataStream API Marketplace™

Consumer Health Gateway

Accelerating Consumer Access & Payer Compliance Through FHIR®-Enabled Real-Time Clinical Data Exchange

The CMS Interoperability and Patient Access final rule (CMS-9115-F), released March 9, 2020, as part of the 21st Century Cures Act, is changing the way health plans do business by requiring the provision of consumer access to patient- and provider-specific information.

Will You Be Ready By July 1, 2021?

  • Do you have a plan to have a Patient Access API and Provider Directory API set up and tested less than a year from now?
  • Do you have an enterprise-wide approach to address your Medicare Advantage, Commercial ACA and Medicaid/CHIP plans?
  • Do you already have deep FHIR®-based API expertise?
  • Do you have a health plan data management model in place?
  • Do you have proficiency in application validation and consumer authentication?

Inovalon Consumer Health Gateway™, a Fast Healthcare Interoperability Resources (FHIR®)-based solution module of the Inovalon ONE® Platform, makes it easy, safe, fast and cost effective for health plans with Medicare Advantage, Commercial ACA and Medicaid/CHIP insurance products to comply with the new application programming interface (API) requirements effective July 1, 2021. Inovalon’s Consumer Health Gateway will also pave the way for applications that empower consumers to access and benefit from their own personal healthcare data in real time.

With a simple daily data feed, health plans can leverage Inovalon’s unrivaled nationwide connectivity infrastructure and expertise in data management and advanced technologies to easily and efficiently comply with rapidly approaching regulatory deadlines while gaining expanded data insights into your membership.

The Inovalon Difference

  • Unparalleled data access and expertise
  • Best-in-class data integration, mapping and standardization
  • Highest-caliber security and compliance
  • Consumer-centric focus with UX in mind
  • Rapid, Streamlined Implementation with an integrated solution that grows with you

Learn more >

CMS Interoperability Rule Requirements & Upcoming Deadlines

Patient Access API Provider Directory API Payer-to-Payer Data Sharing2
Deadline for Compliance July 1, 2021 July 1, 2021 January 1, 2022
What? Health plans must enable members to access their healthcare data through third-party applications via a standards-based API Health plans must make provider directory information publicly available (name, address, number, network, and type) via a digital endpoint on their website Health plans must enable the exchange of certain patient clinical data at the patient’s request via a standards-based API
Who? Medicare Advantage organizations, Medicaid and CHIP FFS programs, Medicaid managed care plans, CHIP managed care entities, and QHP issuers on the FFEs Medicare Advantage organizations, Medicaid and CHIP FFS programs, Medicaid managed care plans, and CHIP managed care entities Medicare Advantage organizations, Medicaid managed care plans, CHIP managed care entities, and QHP issuers on the FFE
Data Requirements: Adjudicated claims, encounter data from capitated providers, clinical data, drug claims and formulary data Provider names, addresses, phone numbers, and specialties Clinical data under U.S. Core Data for Interoperability (USCDI) version 1
Timing: Data must be made available no later than one (1) business day after a claim is adjudicated or encounter data are received Provider directory updates must be available through the API within 30 days of receipt of new data or directory updates Claims dating back to 2016 and transferable for up to 5 years

 

Learn more about Inovalon Consumer Health Gateway™.

1 In partnership with Carequality
2 Solution to be released in 2021
Consumer Health Gateway
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