About Inovalon
FOR PROVIDERS
Improved quality ratings and five-star
reimbursement
Improved clinical and quality
outcomes
CLINICAL
AND
QUALITY
OUTCOMES
Improved risk score insight
and reimbursement accuracy
Decreased unnecessary utilization
Increased continuity of care within
health systems and accountable care
organizations
Improved utilization, insight, and
performance
Increased insight into operational,
financial, and clinical performance
Better provider decision support
Enhanced care coordination
Decreased unnecessary utilization
Increased patient disease, comorbidity,
and care management insight
Lowered fraud, waste, and abuse
Higher member retention
CLAIMS AND
PAYMENT
INTEGRITY
CARE
COORDINATION AND
ENHANCEMENT
FOR MEMBERS
FOR PHARMA AND RESEARCH
Improved clinical and quality
outcomes
Increased insight into
comparative effectiveness
Better communication with payers
and providers
Research, development, and
clinical trial support
More awareness of health status and
areas of potential improvement
HEALTHCARE
DATA
INSIGHTS
Adverse event reporting
and surveillance
Business intelligence
Custom datasets and registries
Distributed analytics
Inovalon’s Prospective Advantage solution combines advanced cloud-based
analytics and data-driven intervention platforms to deliver an integrated solution
for identifying and proactively closing gaps in care, assessment, and provider
documentation. Analytics bring meaningful intelligence to all forms of outreach
and intervention—from multi-channel outreach, to web-enabled decision support
platforms and encounter optimization. In addition, Electronic Health Record (EHR)
interoperability embeds gaps in care, quality, and risk score accuracy directly into the
EHR and pushes guided gap alerts at the point of care. Altogether, the highly datadriven approach achieves the right intervention, for the right member, in the right
venue, at the right time.
®
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, data-driven intervention platforms,
and deep subject matter expertise deliver a seamless, end-to-end
capability that brings 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 bringing
to bear the unique capabilities to resolve them. Providing technology
that supports hundreds of healthcare organizations in 98.2% of U.S.
counties and Puerto Rico, Inovalon’s cloud-based analytical and datadriven intervention platforms are informed by data pertaining to more
than 763,000 physicians, 257,000 clinical facilities, and more than
121 million Americans providing a powerful solution suite that drives
high-value impact, improving quality and economics for health plans,
ACOs, hospitals, physicians, consumers and pharma/life-sciences
researchers. For more information, visit www.inovalon.com.
Inovalon
4321 Collington Road
Bowie, MD 20716
301-809-4000
www.inovalon.com
© 2015 by Inovalon. All rights reserved.
The Inovalon spiral is a registered trademark of Inovalon.
Turning Data into Insight, and Insight into Action® is a registered trademark of Inovalon.
Prospective Advantage® is a registered trademark of Inovalon.
MORE2 Registry® is a registered trademark of Inovalon.
ePASS® is a registered trademark of Inovalon.
Star Advantage® is a registered trademark of Inovalon.
Prospective Advantage®
FOR PAYERS
Prospective Point-of-Care Risk Adjustment Accuracy
Inovalon is a leading technology company that combines advanced
cloud-based data analytics and data-driven intervention platforms to
achieve meaningful insight and impact in clinical and quality outcomes,
utilization, and financial performance across the healthcare landscape.
Prospective
Advantage®
PROSPECTIVE,
POINT-OF-CARE
RISK ADJUSTMENT
ACCURACY
Inovalon’s prospective, point-of-care risk adjustment
accuracy solution proactively identifies gaps in
care, assessment, and provider disease burden
documentation to improve health plan risk score
accuracy, utilization, and retention.
Operational coverage in more than 98.2% of U.S. counties and Puerto Rico | More than 2,500 employees and analytical systems impacting more than 257,000 clinical facilities and 763,000 practitioners nationwide | Analytics informed by more than 9.6 billion medical events
Inovalon’s Prospective Advantage® solution combines advanced
cloud-based analytics and data-driven technologies to
drive targeted interventions designed to close gaps in care,
assessment, and provider disease burden documentation.
Prospective Advantage’s predictive analytics are powered by
the expansive national dataset residing in its MORE2 Registry®
data warehouse and clinically-driven analytics for big data
processing. Unlike traditional prospective risk adjustment
solutions focused solely on in-home assessments, Prospective
Advantage® facilitates the right face-to-face patient encounter,
empowering providers with point-of-care decision support
via interoperable and patient-specific analytics embedded
in the provider’s Electronic Health Record (EHR) system.
In addition, Inovalon’s web-enabled, decision support tool,
ePASS®, pushes gap-resolution alerts and guided questions
to providers—at the provider’s office, at a partner retail
clinic (e.g., Healthcare Clinic at select Walgreens), or in
the member’s home. Prospective Advantage® provides the
industry’s most comprehensive prospective gap identification
and resolution solution for Medicare Advantage, managed
Medicaid, and commercial ACA health plans.
Patient-Specific Encounters
AGGREGATE client
available data
Inovalon’s iPORT ™ data integration system
accepts available health plan data seamlessly
and securely in clients’ native formats.
Petabytes of disparate healthcare data flow
into Inovalon on an ongoing basis, subjected
to more than 1,100 data integrity checks and
data management processes. Our experts alert
health plans and resolve issues to achieve an
industry-leading array of comprehensive data
feeds informing Inovalon’s analytical systems.
ANALYZE data to identify
gap closure opportunities
Inovalon’s proprietary, clinically-driven algorithms
apply thousands of advanced predictive analytics
routines to determine gaps between known and
suspected diagnoses and comorbidities. Insight
from more than 9.6 billion medical events,
residing in our MORE2 Registry® data warehouse,
further reveals a complete spectrum of risk score
accuracy improvement opportunity. Our predictive
analytics identify member-level clinical gaps
and inconsistencies across various care settings
with great specificity. Prospective Advantage®
evaluates previous care interventions to prioritize
suspected diagnoses and opportunities to improve
care and financial outcomes.
Encounter Facilitation intervention connects members with their
providers to encourage targeted and informed encounters. Comprehensive
member-specific historical profiles and associated analytically-driven
healthcare gaps are sent to the provider to enable improved insight
into their patients’ needs for assessment and documentation. Inovalon
contacts the members to encourage them to schedule a provider visit.
Inovalon’s EHR Interoperability
to inform the right intervention,
for the right member, in the right
venue, at the right time
Prospective Advantage® distinguishes itself by applying
advanced analytics to patient, provider, venue, and timing
considerations using integrated EHR data to deliver
comprehensive targeting and execution of interventions
that drive high impact and value. The targeted
interventions close identified gaps in care, assessment,
and provider disease burden documentation.
Encounter Support equips providers with targeted patient-specific,
point-of-care decision support through an advanced, web-accessible
platform—ePASS®. This sophisticated tool empowers the provider with
patient profiles aggregated from administrative claims, medication
prescription and adherence history, diagnostic results, provider
encounter history, and other supplemental datasets. Inovalon’s EHR
interoperability initiative uses targeted patient-specific analytics to
deliver point-of-care risk score accuracy that directly impacts health
plan quality outcomes and financial performance. These embedded
predictive analytics further deliver insight into their patients’ gaps
in care, assessment, and provider disease burden documentation to
improve clinical and quality outcomes.
Supplemental Member Encounters (SMEs) leverage the same platform,
ePASS®, to achieve data-driven encounters in multiple venues. To
accommodate member needs, provide convenient access to providers,
and overcome issues associated with access to care, Inovalon has
designed a multi-pronged approach that facilitates encounters in the
member’s home, or at a partner retail clinic (e.g., Healthcare Clinic
at select Walgreens). The resulting data from these encounters drives
diagnosis accuracy, care improvement, regulatory compliance, and
coordination with the member’s provider to ensure continuity of care.
Member Engagement
Inovalon’s fully integrated solution leverages advanced cloud-based
analytics and data-driven intervention platforms for deep member
insights and targeted member encounters to improve quality of care
and increase member engagement. With personalized outreach and
communication tactics, Inovalon motivates members to complete a
health assessment to close gaps in care and documentation.
APPLY predictive analytics
Prospective Advantage® works to leverage existing
provider relationships, while addressing barriers to
care and the health plan’s financial goals.
INFORM through
dynamic tracking and
financial reporting
INDICES™ is Inovalon’s business
intelligence and financial reporting
solution that provides health plans
insight into process status and
results, including detailed provider
and member reporting, information
about encounters, and financial
impact analysis. Inovalon’s comprehensive suite of reporting
and analytical tools provides the
transparency necessary for health
plans to gain insight into their
business performance.
Inovalon’s analytical systems identify gaps in care, quality, and
risk score accuracy that are embedded directly into EHR partners’
workflow systems. Gap resolution alerts empower the point of care
through integrated EHR systems.
IMPROVE through
integration
ePASS® delivers
member-level
insight to enable
significant improvements in
risk score accuracy, utilization,
and quality improvement.
ePASS® offers providers
guided decision support
where EHR interoperability
has not been achieved.
Prospective Advantage® improves
care and insight, driving greater risk
score accuracy, utilization efficiency,
and membership satisfaction,
when combined with Inovalon’s
quality improvement solution,
Star Advantage®. This integration
delivers unparalleled improvements
in quality and financial performance.
Seamless integration with HCC, CDPS, ACG, DxCG, and CRG risk factor model systems | Healthcare data subjected to more than 1,100 data integrity checks and data management processes | Clients include hundreds of healthcare organizations impacting more than 121 million members