Quality Management

quality management

Unified Quality Management

Align payers, providers, pharmacies, and members to drive measurable improvements in quality performance.

Transform your quality programs

The Healthcare Intelligence Cloud enables both providers and payers to improve quality performance and deliver better care to patients.

For Providers

Seamlessly integrate risk adjustment into clinical workflows with point-of-care tools that surface suspected conditions, documentation gaps, and clinical evidence.

For Payers

Transform your risk adjustment performance with AI-powered analytics that drive both prospective and retrospective programs.

For payer

Engage Providers on Quality Performance at the Point of Care

For provider

Elevate Quality Metrics and Meet Compliance with Quality Management

The Quality Management Suite

Quality Measure Support

Support for all major quality programs including HEDIS®, Stars, and ACO measures, with real-time monitoring and risk-adjusted benchmarking. Custom measure development ensures you can track what matters most to your organization.

Engagement Tools

Enable seamless collaboration between providers and pharmacies while coordinating member outreach campaigns. Integrated communication tools and patient education resources ensure everyone stays aligned on quality initiatives.

Analytics & Insights

Transform data into actionable insights through sophisticated analytics that highlight opportunities for improvement. Track ROI and population health metrics while predicting future performance trends.

Technology Foundation

Built on a FHIR-based architecture with NCQA-certified data aggregation, our platform ensures reliable data integration and secure information exchange. Automated workflows streamline everything from chart chase orchestration to member outreach, while maintaining full regulatory compliance and audit readiness.

Population health teams recognize better outcomes with Innovaccer

"The Innovaccer platform enhances our understanding of patient populations and helps us make accurate diagnoses, establish and automate TCM protocols, and bridge care gaps. This holistic approach helps us to deliver a seamless, comprehensive healthcare experience for our patients and families"

Dr. Amanda Furr

VP of Population Health at Pediatrics Associates

“Innovaccer is one of those partners that we work with in order for us to get more value out of the data that we have. We have many different EMRs”

Seth Staton

Head of Clinical Programs & Innovations, Walgreens

improvement in coding and documentation accuracy at

Powered by a unified data model that links disparate data sources

Integrate

Raw data is received from source systems & stored in a data lake.
‍

3X

more accurate than off-the-shelf AI

Harmonize

Data is parsed & codified, then stored in a simple data structure.

3X

more accurate than off-the-shelf AI

Unify

3X

more accurate than off-the-shelf AI

Patient & provider information are aggregated into a single record.

Process

Intelligent algorithms enrich the data with quality measures, gaps in care, & more.

3X

more accurate than off-the-shelf AI

Analyze

Data is denormalized into a structure for analytics & AI.

3X

more accurate than off-the-shelf AI

Integrate

Raw data is received from source systems and stored in the lake before any processing and interpretation. Your original data is always available to diagnose any issues and enable reprocessing as issues are resolved.

Integrating data in 16 states for

2800

data elements supported

Unify

Patient and provider information are aggregated into a single record containing multiple sources of information through Master Data Management functionality, including an Enterprise Master Patient Index, and data curation to remove redundancies. The data at this level is leveraged for application functionality and downstream processing.

Unifying records at

54M

patient records unified

Harmonize

The raw data is parsed and codified, then stored in a simple and clean data structure without complex relational features. The data at this level is typed and coded to the UDM’s ontology and ready to be processed into the downstream structures, which are leveraged for applications and analytics.

Harmonizing clinical and claims data at

6000

data quality rules applied

Process

Intelligent algorithms enrich the data the previous stage with deep insights. Out of the box, this includes each patient’s disposition toward quality measures (numerator, denominator, exclusions), risk and social vulnerability profiles, gaps in care, engagement data, next best actions, and more.

Improving documentation accuracy at

10%

improvement in quality gap closure

Analyze

Analytics summarize and denormalize the data from Unify and Process stages into a multidimensional data cube structure optimized for analytics, AI, workflows, and additional data visualization use-cases.

Bringing analytics and AI to

22%

reduction in readmission rates

An integral part of the value-based care suite

Risk adjustment

Transform your risk adjustment program with intelligent workflows and real-time insights that improve coding accuracy and patient outcomes.

Care Management

Innovaccer's Care Management Copilot uses advanced AI to automate documentation, generate care insights, and predict patient risk.

Contract management

Build predictable revenue models, strengthen contract negotiations, and maximize financial performance in value-based care.

Population Health Analytics

Population Health Analytics leverages the full power of the Data Activation Platform to deliver actionable insights that drive performance in value-based care.

Frequently Asked Questions

What quality programs does your platform support?

Our platform provides comprehensive support across multiple quality programs through a single integrated system. This includes HEDIS, Star Ratings, HEDIS, UDS, MSSP, ACO REACH, MIPS, etc. With our NCQA-certified measure engine, we support both standard and custom measures, enabling health plans to manage all their quality reporting requirements through one solution.

How do you support HEDIS® reporting and submissions?

We provide end-to-end HEDIS® reporting support through our NCQA-certified solution. This includes administrative, hybrid, and ECDS measure calculation, certified sampling, automated chart chase and abstraction workflows, performance dashboards, and complete audit support. Our platform handles everything from data collection through final IDSS/PLD submission, ensuring compliance with NCQA requirements while streamlining the entire process.

What capabilities do you offer for care gap closure?

Our platform enables multi-channel gap closure through coordinated interventions across providers, pharmacies, and care teams. We offer EMR-integrated provider alerts through a point-of-care solution called InNote, and a pharmacy engagement solution called EQUIPP®. Health plans can track gap closure activities in real-time and orchestrate interventions across their entire network, achieving up to 90% year-end gap closure rates.

How does your pharmacy quality network support quality improvement?

Our platform connects health plans with 95% of pharmacies nationwide through EQUIPP®, enabling enhanced pharmacy services such as blood pressure readings and A1C screenings. Pharmacies can view patient opportunities, perform outreach, and document screenings directly in the platform.

What kind of data integration and management capabilities do you provide?

As an NCQA-certified Data Aggregator, we offer comprehensive data management capabilities built on a USCDI/FHIR-based platform. This includes extensive pre-built data connectors for claims, EMRs, HIEs, and labs, 7,000+ data quality rules, unified data modules for administrative and clinical data, and advanced security features including HITRUST and SOC2 compliance. Our platform ensures high-quality data integration while maintaining complete audit trails.

How do you support year-round quality monitoring and improvement?

Our solution provides continuous quality monitoring through high-frequency measure calculation and real-time performance dashboards. Quality teams can access rate performance reporting, gap closure surveillance, and detailed KPIs throughout the year. We offer automated targeting and workflow tools for outreach coordinators, point-of-care insights for providers, and comprehensive analytics for tracking progress against benchmarks and goals. This enables proactive quality improvement rather than just annual reporting.

Learn how to unlock the full potential of your healthcare data

whitepaper

Innovaccer’s Data Activation Platform: What Makes it the Best in KLAS Data and Analytics Platform

whitepaper

Five Reasons Why the Modern Payer Needs a Data Activation Platform

Experience Quality Management today