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Population Health Insights

The nationwide outbreak of COVID-19 has placed strain on healthcare systems and resulted in preventive measures such as closed businesses and stay-at-home orders. The future of COVID-19 is still unknown and while we may not know what COVID-19 has in store for the U.S. for the rest of 2020, we can use data to monitor the outbreak and inform pandemic response efforts. Inovalon has added a complimentary dashboard to its Population Health Insights solution. This COVID-19 Compass dashboard not only tracks the prevalence of COVID-19 cases but also identifies the most at-risk populations to provide a comprehensive view of geographic areas with insight into clinical and non-clinical data to improve health outcomes. Learn More.

Inovalon’s Population Health Insights, powered by the Inovalon ONE® Platform, integrates and enriches clinical, social determinants of health (SDOH), and national and regional benchmark data to provide health plans with a holistic view of members within a population. A more comprehensive view of their membership allows health plans to assess not only clinical care but also non-clinical needs to better understand the underlying factors that affect the health of a population. Health plans can then use that data to determine how to address the overall needs of a population to improve health outcomes and reduce the cost of care.

Common Challenges Inovalon’s Population Health Insights Solution
× Lack of integration from disparate data sources Data Breadth & Depth: Longitudinally linked, normalized and validated healthcare data pertaining to more than 63 billion medical events and more than 338 million patients
× Lack of holistic view of member population and insight into the population’s SDOH Population Segmentation & Risk Stratification: Provides a more holistic view of member care informed by clinical and non-clinical data elements (e.g. demographics; SDOH)
× Limited comparative data to evaluate performance against national and regional benchmarks Advanced Benchmarking: Comparative analysis against national and regional benchmarks identifies areas for improvement
× Case management programs don’t address the clinical and non-clinical needs of each member Predictive Analytics: Identify, predict and prioritize at-risk populations to inform the optimal member-specific intervention strategy that addresses clinical and non-clinical needs of each member
× Limited resources for case management programs and interventions Operational Efficiency & Cost Savings: Integrate and inform existing strategic programs and allocate resources where they have the biggest impact (e.g. quality improvement, case management, risk programs)
× Current tools do not support NCQA Population Health Management Accreditation Pre-validated by NCQA for Population Health Management Accreditation standards

Population Health Insights Use Cases

Understand your population with a holistic view of members and their care

  • Evaluate the prevalence of a disease by SDOH factors to identify population segments requiring attention
  • Assess a sub-population’s disease prevalence by location to compare with national and regional benchmarks

Enhance economic performance by improving quality care and reducing costs

  • Segment your member population to obtain insights into your population mix and compare against benchmarks
  • Measure the disease prevalence and risk profile to forecast the expected healthcare utilization and cost of your population subgroups

Allocate resources where they have the biggest impact

  • Analyze the number of members by condition that reside in rural versus urban areas and the volume of managed populations with specific diagnoses within certain counties

Inform quality improvement initiatives

  • Perform rapid segmentation of your member population to isolate patients targeted for intervention
  • Gain easy access to member contact information, provider information, utilization profile, and other details needed for interventions


NCQA Pre-Validation for Population Health Management

By using Inovalon’s Population Health Insights, health plans receive automatic credit for applicable NCQA Population Health Management accreditation standards. Inovalon is the only pre-validated Population Health Management vendor that is also NCQA certified for HEDIS® reporting1, serving as a one-stop shop for your quality measurement, reporting and improvement needs.

With the ability to stratify sub-populations by their risk profile and level of resource utilization, health plans can perform assessments of these various sub-populations and gain data-driven insights to inform quality improvement initiatives.

Population Health Analytics & Risk Stratification

Driving our population health analytics is Inovalon’s MORE2 Registry®, the nation’s largest primary source dataset, comprised of data from more than 338 million patients and 63 billion medical events. The breadth and depth of the MORE2 Registry® is the backbone of Inovalon’s Population Health Insights, allowing for the incorporation of SDOH data, consumer data, and national and regional benchmarks for a holistic view of members.

Data on SDOH is derived from multiple, comprehensive individual and household databases including government data and self-reported data. This data is available at the ZIP+4 level, which covers approximately 30 million discrete geographic areas, with an average of approximately five households per neighborhood providing a precise assignment of social risk factor characteristics. Sociodemographic and community-resource characteristics at this near-neighborhood level can serve as close proxies for these characteristics at the member level and are highly predictive of health behaviors.

The Johns Hopkins ACG® System

Inovalon has incorporated the Johns Hopkins Adjusted Clinical Groups® (ACG®) System to deliver predictive analytics and condition grouping to identify diagnostic risk and create the appropriate case mix to predict health outcomes at the patient, subgroup and population level. The advanced analytic algorithms use data from medical claims, health records and demographic data to deliver patient insights. The ACG® system tracks morbidity and layers on predictive member cost and utilization risk indicators to stratify populations. Where many other methodologies categorize patients by events, the ACG® System looks at the overall health of an individual and their morbidity over time, providing a more complete picture of a population.

Data Visualization and Reporting

A layer of business intelligence is wrapped around the core components of Inovalon’s Population Health Insights solution to showcase and interactively toggle between population cohorts. Built on the foundation of Inovalon’s Data Visualization and Reporting platform, these reports aim to answer questions within the healthcare ecosystem to track disease prevalence, offer insight into care coordination, provide intervention support and drive positive quality outcomes.

Improving Care through Intervention Planning & Resource Allocation

With Inovalon’s Population Health Insights, health plans can garner insights into their population mix by segmenting the member population by chronic conditions, risk level, mental health and surgical- and obstetric-related aspects and measure the disease prevalence and risk profile to forecast healthcare utilization and predict the prospective cost risk at the population and member level. This allows health plans to identify high-risk, high-cost members for intervention programs.

Insights derived from these advanced analytics inform effective intervention strategies to target and engage the right member, though the right channel, with the right data, at the right time and enable health plans to allocate resources where they have the biggest impact. Addressing the needs of these high-risk, high-cost members through effective intervention planning results in improved health outcomes and enhanced economic performance through the reduction of long-term utilization costs.

The MORE2 Registry®, coupled with our data integration and validation capabilities, the Johns Hopkins ACG® System analytics, SDOH and predictive analytics equips health plans with actionable insights needed to achieve improved quality outcomes and economic performance through a population-based approach.

1 As of April 1, 2020

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