The Inovalon Payer Cloud is a comprehensive, cloud-based suite of software solutions and analytics specifically designed for health plans (payers). Built on the Inovalon ONE® Platform, it transforms traditional, disconnected payer workflows into data-driven processes to support key organizational goals, including improving clinical quality metrics, risk score accuracy, and value-based care program management.
Key Features and Capabilities:
- Converged Quality: Provides the market's leading HEDIS® certified engine for CMS, NCQA, and state data submissions, empowering teams with quality measurement software to manage and improve quality ratings.
- Converged Risk: Offers advanced analytics and flexible member engagement solutions to ensure efficient and accurate documentation of member conditions, supporting risk adjustment programs (CMS-HCC, HSS-HCC, etc.) and audit readiness.
- Converged Provider Enablement: Translates organizational goals to the provider point of care with shared insights into patient care quality, documentation, program performance, and utilization metrics to align health plans and providers in value-based care.
- Converged Outreach: Consolidates all intervention activities and vendors to ensure members receive the right interaction at the right time, making member outreach easier and more patient-centric.
- Inovalon Healthcare Data Lake: Provides a single source of truth to store, enrich, and analyze complex claims and clinical data, leveraging the company's extensive primary source healthcare dataset.
- Electronic Record On Demand: Clinical data extraction software to access digital medical records rapidly, securely, and cost-effectively for use in quality and risk programs.
Target Users and Use Cases:
The primary target users are large to enterprise-level Health Plans and other Payer Organizations. Key use cases include Quality Measurement & Reporting (HEDIS/Star Ratings), Risk Score Accuracy & Adjustment, Value-Based Care Program Management, Population Health Analysis, and Member & Provider Engagement.
