payer

Improve the member experience. Lower the cost of care.

The first unified platform to improve provider and pharmacy quality, member outreach, and risk adjustment, improving outcomes across your entire population.

Improve quality with the only integrated payer platform

The Healthcare Intelligence Cloud brings a suite of performance-driving solutions to improve enterprise performance and healthcare quality.

Drive provider and pharmacy quality

Leverage the largest national network of pharmacies and providers to close care gaps, improve quality metrics, and deploy value-based care programs.

Improve risk score accuracy

Accelerate accurate risk capture with point-of-care tools that identify coding gaps and opportunities across your provider network.

Increase member engagement

Drive better outcomes through personalized, omnichannel engagement that meets members where they are with the right message at the right time.

Healthcare Intelligence for Payers

Integrated quality management

Risk score accuracy

Member Outreach & Engagement

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Integrated quality management

Drive Pharmacy and Provider Quality

Transform your quality programs through the first unified platform that enables providers and pharmacies to drive comprehensive quality improvement and close care gaps at the point of care.

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Risk score accuracy

Drive Accurate Risk Capture

Get accurate risk scores while reducing costs, turning risk adjustment into a member-focused program improving care and enhancing provider coding.

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Member Outreach & Engagement

Intelligent Member Engagement That Drives Results

Enable data-driven outreach strategies that improve member activation rates and close care gaps through intelligent campaign orchestration and real-time response tracking.

All powered by the
Data Activation Platform

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 optimized for analytics, insights, & workflows.

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

SPOTLIGHT

Empowering health plans to improve member outcomes through value-based pharmacy programs

EmblemHealth, one of the nation's largest nonprofit health insurers, partnered with Innovaccer to launch New York's first pharmacy value-based arrangement focused on improving health outcomes for members with diabetes and hypertension.

INNOVACCER SERVES EMBLEMHEALTH BY:

Building a unified data foundation to power pharmacy quality programs and care management initiatives that connect pharmacies, providers, and care teams in delivering coordinated, whole-person care.

Augmenting and automating pharmacy engagement, quality reporting, and care team workflows to enable timely interventions and close critical care gaps for chronic conditions like diabetes and hypertension.

Why did Emblem Health choose PQS by Innovaccer?

Read THE REPORT

Empowering government health leaders to serve their citizens

“Our partnership with Pharmacy Quality Solutions enables us to strengthen relationships with the city’s pharmacies—the cornerstones of community care—while continuing to redefine the scope and reach of healthcare access for members at every touchpoint.”

Abdou Bah

Chief Health Equity Officer of EmblemHealth

“By making data more accessible and accurate, and using AI in practical ways, we can actually solve the day-to-day challenges that providers and payers face.”

Nick Moriello

President of Highmark Blue Cross Blue Shield Delaware

Meet with our
 payer team.