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To succeed in today’s increasingly data-driven healthcare landscape, healthcare payers need advanced analytics and actionable insights to meaningfully improve the health of their member population. 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 19 of the top 25 U.S. health plans.

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
Provider Performance Improvement
Provider Performance Improvement
Strategic Advisory Services
Strategic Advisory Services
Automated Medical Record Retrieval & Review
Automated Medical Record Retrieval & Review

Quality Measurement, Reporting & Improvement

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

Through an integrated, modular approach, Inovalon empowers health plans and provider systems participating in federal, state and accredited quality measurement programs to 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 70% of the nation’s organizations, delivering up to 15 times faster processing speeds to drive improved quality performance.

Our quality solution delivers more than simply results tracking and reporting—we provide 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 resources to meaningfully improve quality, 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. By knowing where you stand versus the rest of the market and providing the capabilities to improve upon results, Inovalon’s Platform empowers organizations to focus resources on the right areas and achieve the precise improvement needed.

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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 CSM-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.

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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 score accuracy program. With so much at stake, the ability to accurately and efficiently capture member-specific risk adjustable diagnosis codes and address gaps in disease diagnosis documentation with best-practice compliance is essential.

Putting data to work for the improvement of healthcare quality and financial performance is key to helping organizations succeed. That’s why Inovalon developed the industry’s most advanced suite of products that drive risk-score accuracy and compliant claims submissions, empowering our clients’ success. As a part of the Inovalon ONE® Platform, Inovalon’s solutions drive risk score accuracy through integrated end-to-end solutions or through independent programs that deliver meaningful improvements in disease documentation and coding accuracy, serving not only the goal of improving insight into members’ disease and co-morbidity status but also accurate payments and best-practice compliance programs.

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Risk Score Accuracy Improvement & Submissions

Provider Performance Improvement

Achieving a high-performing provider network requires data-driven insights to target provider performance, coupled with data visualization and transparency to support the design, management, monitoring and engagement of superior provider networks. With Inovalon’s end-to-end provider performance improvement solution, health plans have the flexibility to leverage these capabilities based on their specific needs to build and maintain the highest-performing provider network.

Leveraging Inovalon’s Provider Portal, health plans can further support value-based care initiatives by providing their provider network with actionable insights from a “single source of truth”—delivering transparency and the ability to track and improve performance. With these insights provided in real time, health plans are able to deploy provider-specific targeting to influence performance and compliantly adjust their network while empowering individual practitioners to rapidly gain insight into their patients’ care to support their value-based goals. Inovalon’s flexible implementation approach enables clients to tailor a solution that will complement their current program or provide full, end-to-end capabilities.

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Provider Performance Improvement

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.

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Strategic Advisory Services

Automated Medical Record Retrieval & Review

More than 100 million clinical medical record 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—let alone the associated costs.

Inovalon’s automated solutions leverage machine-learning technology and our extensive connectivity with more than 180,000 providers to deliver superior results in minutes. This autonomous process captures comprehensive, rich critical data for all needs that would benefit from capture of the 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.

Informed by the analysis of more than 90 million pages of medical record data, our natural-language processing (NLP) capabilities autonomously analyze collected clinical medical record data to identify critical patient data pertaining to quality, risk, utilization, and outcomes.

The combination of our autonomous aggregation and real-time NLP analysis results in dramatically increased accuracy, reduced process times, eliminated provider friction and significant cost savings.

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Automated Medical Record Retrieval & Review
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