Close Gaps, Boost Ratings and Improve Lives

Track quality metrics, close care gaps faster, and improve Star & HEDIS performance all with one intelligent platform built for proactive quality management.
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Comprehensive Quality Analytics and
Gap Closure for Payers

End-to-end integrated workflows across 
office, pharmacy, and home

Quality Analytics Engine

Real-Time Quality Analytics for Better Ratings & Outcomes

Unlock the full value of your data with AI-driven risk adjustment that powers accurate coding, seamless gap closure, and improved RAF and quality performance.

Real-time performance tracking - HEDIS and Star measures to drive timely, data-informed interventions.

Streamline chart chasing, abstraction, and submissions boosting gap closure rates

NCQA-certified quality workflows to improve rating and compliance

Prospective & Concurrent Reviews

Proactive Gap Closure at the Point of Care

Track quality metrics, close care gaps faster, and improve Star & HEDIS performance—all with one intelligent platform built for proactive quality management.

Surface quality gaps before the patient visit to enable timely intervention

Close gaps with Pharmacy Copilot to drive medication adherence and at-home test kits to streamline closure of care gaps beyond the clinical setting

Provider Copilot delivers in-workflow insights to support accurate documentation and coding

Retro+ Reviews

Retrospective Intelligence for Complete and Compliant Risk Capture

Innovaccer’s Cost of Care empowers payers to identify cost drivers, improve care quality, and optimize value-based care performance on a unified data and analytics platform. From surfacing actionable insights to streamlining contract execution, we help health plans make smarter, faster decisions across their entire population.

Identify and capture previously unsubmitted or undocumented diagnosis codes to improve RAF scores

Detect missed coding and documentation gaps across historical clinical and claims data

Leverage bi-directional claims and chart reviews for comprehensive and accurate risk adjustment

Chart Abstraction & Retrieval Platform

Chart Retrieval to Accelerate Quality Reporting & Gap Closure

Empower payers to design, manage, and optimize value-based care (VBC) programs with precision. From identifying cost drivers and savings opportunities to benchmarking against the market, our solution combines rich analytics, predictive models, and actuarial expertise to help health plans make smarter, faster, and more strategic decisions.

HCC coding to optimize RAF

Charts to be retrieved and allowed for quality & HEDIS abstraction

Faster gap closure through timely access to clinical documentation

All powered by the
Data Activation Platform

Labs
Pharmacy
Claims
EMRs
SdoH
Consumer & Digital Health
Third-party Data
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
Drive VBC performance
Deliver intelligent experiences
Reduce provider burden
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

Drive outcomes without the extra cost, or the stress

AI-powered Efficiency

Eliminate tedious, manual workflows with intelligent automation

Accurate Gap Identification

Advanced risk and quality gap analytics ensuring no opportunity is missed.

Maximize Impact

Reduce administrative overhead by minimizing paperwork and inefficiencies.

Seamless Integration

Works effortlessly with your existing systems, supporting bi-directional integration with 200+ EHRs.

Enterprise-grade Security & Compliance

Safe and secure with HIPAA, HITRUST, SoC2 compliance

An integral part of the value-based care suite

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.
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Risk adjustment

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

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

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

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

Leading Healthcare Organizations Choose Innovaccer

“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
“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
Resources
News
Effective Payer-Provider Collaboration - An Activation Agent for Improved Health Outcomes
November 21, 2024
Innovaccer surveyed 65 payer organizations to evaluate provider network management expenditure, network size, and organizational challenges, priorities, preferences, and use cases. This report summarizes the survey results and explores how payer organizations navigate the challenges of networ
News
Improving Payer Risk AdjustmentThrough the Power of Data and Provider Connectivity
August 9th, 2024
As the government tightens and scrutinizes risk adjustment practices in the future, health plans must align their practice with accurate member diagnosis and treatment data.

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

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white paper

Five Reasons Why the Modern Payer Needs a Data Activation Platform

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Meet with our payer team.

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