Inovalon Launches AI-Powered Converged Record Review To Improve Risk Score Accuracy for Health Plans

SaaS Solution Uses Advanced Natural Language Processing and Machine Learning to Automate Medical Record Reviews and Enhance Risk Adjustment Performance

BOWIE, Md., Oct. 17, 2024 (GLOBE NEWSWIRE) — Inovalon, a leading provider of cloud-based software solutions empowering data-driven healthcare, today announced the launch of its AI-powered Converged Record Review, a new SaaS solution designed to help health plans streamline the risk adjustment process with advanced technologies and analytics. By automating the identification of medical records with and without clinical documentation value, the solution reduces unnecessary manual medical record reviews by up to 50% and helps direct resources to better focus on medical records that are highly likely to have valid diagnosis documentation, boosting accuracy and efficiency, while also reducing wasted time and lowering costs associated with risk adjustment programs.

As the shift to value-based care continues, health plans increasingly rely on data from medical records to support comprehensive and accurate documentation and reporting, a process that has historically been costly and resource-intensive. Inovalon’s Converged Record Review equips health plans with natural language processing (NLP) and machine learning (ML) capabilities to better analyze targeted medical records and accurately identify which ones are likely to produce meaningful clinical value and documentation insight. This allows health plans to focus resources on high-value medical records that can significantly impact patient clinical data accuracy and associated risk adjustment performance. 

Powered by the Inovalon ONE® Platform – the largest and most comprehensive primary source dataset in U.S. healthcare – Converged Record Review is built upon more than 18 years of expertise in conducting medical record reviews. The software continuously improves accuracy by learning from corrections, reducing false positive identification rates by up to 50%, which in turn reduces manual reviews by up to 25% and decreases spending on manual reviews by up to 25%. Additionally, integration with Inovalon’s Converged Risk solutions helps identify and confirm additional risk-adjustable medical conditions which may otherwise go unidentified or inadequately documented.

“Advanced data analytics and automation are essential for helping health plans manage value-based care without the burden of high-cost and time-consuming manual record reviews,” said Mike Jones, President and General Manager of Inovalon’s Payer Business Unit. “By combining Inovalon’s industry-leading dataset with next-generation natural language processing and machine learning models, Converged Record Review enables health plans to operate more efficiently, reduce manual workloads, and enhance risk score accuracy for better clinical and financial outcomes.”

Converged Record Review is fully interoperable with Inovalon’s Payer Cloud and Converged solution suite – a set of integrated, pure SaaS offerings that provide data-driven insights and workflows to improve quality measurement, risk score accuracy, member outreach, and value-based care management. Inovalon’s Payer Cloud is fueled by clinical quality metrics on more than 192 million lives, including 80% of all HEDIS®-covered lives across the United States.

To learn more about Inovalon’s Converged Record Review visit:
https://www.inovalon.com/converged-record-review. General availability is December 2024.

About Inovalon

Inovalon is a leading provider of cloud-based SaaS solutions empowering data-driven healthcare. The Inovalon ONE® Platform brings together national-scale connectivity, real-time primary source data access, and advanced analytics into a sophisticated cloud-based platform empowering improved outcomes and economics across the healthcare ecosystem. The company’s analytics and capabilities are used by nearly 20,000 customers supporting more than 53,000 sites of care, and are informed by the primary source data of more than 85 billion medical events across 1.1 million physicians, 675,000 clinical settings, and 394 million unique lives. For more information, visit www.inovalon.com.

Contact:
Tom Paolella
Sr. Director, Press and Analyst Relations, Inovalon
Thomas.Paolella@inovalon.com