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October 28, 2014

Dual Eligible Medicare Advantage Study Highlights Factors Linked to Diminished Quality Outcomes

Research Expected to Inform Future Discussions around CMS Five-Star Quality Measures and Promote Additional Improvements in Care

Bowie, MD. – Oct. 28, 2014Inovalon, Inc., a leading technology company providing advanced analytics and data-driven intervention platforms to the healthcare industry, today released preliminary results of a groundbreaking study to better understand the association of socioeconomic status (SES) and other factors with underlying poor quality performance of dual-eligible members in Medicare Advantage plans. The research, An Investigation of Medicare Advantage Dual Eligible Member Level Performance on CMS Five-Star Quality Measures, is the most comprehensive to date, and it is intended to inform the ongoing debate on how best to improve upon the existing CMS Five-Star Quality Rating System.

Previous Inovalon research released in October of 2013 provided insight into the phenomena of members of the duals population (those covered by both Medicare and Medicaid) performing worse than non-duals on certain quality metrics. The study, however, stopped short of exploring the underlying reasons.

This expanded analysis reveals new and detailed evidence that demonstrates how differences in dual eligibles’ clinical, demographic and socioeconomic characteristics result in worse performance on a majority of the measures evaluated. While the focus of the study was patient-level analysis, when aggregated to population levels, analysis revealed that duals perform significantly worse, for example, on antidepressant medication management and on all three medication adherence measures, but duals who are disabled or have alcohol/drug/substance abuse, or live in designated shortage areas for primary care physicians and mental health professionals perform even worse on these measures when compared to other duals and non-duals. The large scale data allowed for stratification down to the patient-level for the first time on such scale. Repeatedly made evident through the analysis was the implication of socioeconomic factors. The detailed data resulting from this study can now be used to inform policy, as well as the development of both population-wide and highly-specific patient-level solutions to improve quality in socioeconomically challenging circumstances.

“These new analyses are game-changing and will influence how the industry looks at risk, quality ratings, and patient care for duals,” said Christie Teigland, Ph.D., Director, Statistical Research at Inovalon and principal investigator of the study. “Plans and providers can use these analysis results data to inform quality improvement programs aimed at the patients that need it most. For CMS, it provides evidence that socioeconomic barriers result in greater quality performance gaps, signaling the opportunity to potentially adjust Star ratings and leverage data-driven comparisons of quality across Medicare Advantage plans.”

“Working in collaboration with our clients has enabled Inovalon to conduct the largest multi-payor analytical investigation into the challenges faced by those serving the dual eligible population and provide the most comprehensive, data-driven intelligence to inform healthcare policy makers,” added Keith Dunleavy, MD, Inovalon’s CEO and Chairman of the Board. “We are pleased to be able to play a role in this important analysis, leveraging data to inform how best to achieve quality care.”

For its research, Inovalon utilized member-level data from a number of partnered collaborating health plans and extracted member-level Medicare Advantage data from its Medical Outcomes Research for Effectiveness and Economics Registry (MORE2 Registry®), one of the industry’s largest healthcare datasets. This data was combined with additional sources, including CMS Monthly Membership Reports, U.S. Census data, and detailed market data. The study evaluated performance on 18 Five-Star quality measures for more than 2.2 million Medicare Advantage members drawn from 81 separate Medicare Advantage contracts comprising 364 individual plans.

Inovalon conducted this research in collaboration with Cigna-HealthSpring, WellCare, Healthfirst, Gateway Health, Blue Cross Blue Shield Minnesota and Blue Plus, Health Care Services Corporation, the Special Needs Plan (SNP) Alliance, and Medicaid Health Plans of America (MHPA) and consulted with multiple other industry partners.

About Inovalon

Inovalon is a leading technology company that combines advanced cloud-based data analytics and data-driven intervention platforms to achieve meaningful impact in clinical and quality outcomes, utilization, and financial performance across the healthcare landscape. Inovalon’s unique achievement of value is delivered through the effective progression of Turning Data into Insight, and Insight into Action®. Large proprietary datasets, advanced integration technologies, sophisticated predictive analytics, and deep subject matter expertise deliver a seamless, end-to-end platform of technology and nationwide operations that bring the benefits of big data and large-scale analytics to the point of care. Driven by data, Inovalon uniquely identifies gaps in care, quality, data integrity, and financial performance – while also bringing to bear the unique capabilities to resolve them. Supporting hundreds of healthcare organizations in 98% of U.S. counties and Puerto Rico, Inovalon’s analytical and data-driven intervention platforms are informed by data pertaining to more than 744,000 physicians, 244,000 clinical facilities, and more than 118 million Americans, providing a powerful solution suite that drives high-value impact, improving quality and economics for health plans, ACOs, hospitals, physicians, patients, and researchers. For more information visit


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Phone: 301-809-4000 x1473

Greenough, on behalf of Inovalon, Inc.
Andrea LePain
Phone: 617-275-6526
Cell: 617-894-1153

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