Inovalon, a provider of cloud-based software solutions empowering data-driven healthcare, launches Converged Outreach. This new cloud-based SaaS product is a patient outreach orchestration solution that empowers healthcare organizations to coordinate the analytically-derived patient intervention programs of multiple concurrent initiatives to achieve optimal engagement, impact, and efficiency.
Traditional approaches by health plans and other value-based and outcomes-based organizations often have multiple patient engagement initiatives running simultaneously, such as quality improvement, risk score accuracy improvement, smoking cessation, cancer screening, medication adherence, vaccination management, and others. This frequently results in discordant outreach efforts that confuse patients, drive up costs, and add unnecessary friction to both the patient and their providers.
Inovalon’s new cloud-based Converged Outreach SaaS solution enables healthcare organizations to customize integrated, patient-specific intervention programs and coordinate outreach in one efficient solution. Utilizing predictive analytics informed by the data of billions of medical events, Converged Outreach leverages sophisticated algorithms focused on key elements such as patient compliance likelihood, total impact opportunity, and operational workflow optimization.
Tracking and modifying programs at the patient level in response to past patient engagements, historical intervention performance results, and resource availability are further differentiators of the solution. The resulting coordinated outreach plan is available to the customer in real-time for provision to their existing resources or a growing ecosystem of third-party healthcare services vendors for the outreach plan’s coordinated intervention plan to be undertaken across the identified patients.
“Inovalon believes in personalized care, and in the power of data to drive the right action at the right time,” said Craig Savage, President and General Manager of Inovalon’s Payer business. “With Converged Outreach, customers have a powerful solution at their fingertips to coordinate programs that otherwise have operated in separate silos, now confidently targeting the right coordinated interventions to the right patient at the right time, driving significant improvements to quality of care, economic outcomes, and clinical performance.”
Converged Outreach is fully interoperable with Inovalon’s cloud-based Converged solution suite, a set of integrated, pure SaaS offerings that simplify implementation, shorten the time to program impact, and avoid the need and cost of additional disparate data integrations, data security auditing processes, vendor management, and operational reporting.
Inovalon, a leading provider of cloud-based software solutions empowering data-driven healthcare, today announced the addition of its EASE All-Payer claims management solution to the PointClickCare Marketplace. Building on a five-year partnership, Inovalon’s newest listing on the Marketplace offers healthcare providers sophisticated revenue cycle management (RCM) tools that are seamlessly integrated into PointClickCare’s Electronic Health Record (EHR).
The Inovalon EASE All-Payer claims management software, powered by the Inovalon ONE Platform, helps providers achieve a 99% first-pass acceptance rate among commercial and Medicare payers. The solution leverages an advanced payer rules engine that validates claims based on the latest requirements from the Centers for Medicare & Medicaid Services and Commercial insurers. The solution also allows users to easily create custom, facility-specific business rules that improve the accuracy of claims processed in each location.
Unlike other solutions, EASE All-Payer automatically checks claim eligibility and historical responses upon submission, enabling users to identify and correct upstream eligibility issues before transmitting to the payer. Additionally, the solution’s integration with Inovalon’s MORE2 Registry enables providers to easily source missing patient information, such as the Medicare Beneficiary Identifier, which can significantly reduce claims denials and improve first pass yield.
Also offered on the PointClickCare Marketplace is Inovalon’s Workforce Management solution, a fully mobile, real-time scheduling and open shift management application that scales from single units to entire enterprises. Inovalon solutions available on the Marketplace allow PointClickCare customers to operate within a single platform to launch, manage, and utilize applications, resulting in greater data accessibility and a unified user experience.
“We are pleased to enter the next phase of our long-standing partnership with PointClickCare supporting thousands of providers with the integrated tools they need to optimize financial and operational performance,” said Julie Lambert, president and general manager of the Inovalon Provider business unit. “Inovalon powers thousands of facilities with its industry-leading solutions, and our latest listing on the PointClickCare Marketplace ensures they are easily accessible to our joint customers.”
Included amongst the segments of healthcare such as post-acute care that until recently had been mostly overlooked, specialty pharmacy now is in the spotlight as a key area of healthcare utilization and spend in the U.S. Critical, expensive and often life-sustaining medications for high complexity disease states, as well as care management programs that help patients through their healthcare journey, are at the core, driving nearly $175 billion in drug spend for the 2 percent to 3 percent of the U.S. population considered medically complex. Specialty pharmacy operations typically involve a cross-functional staff of insurance experts, patient care coordinators, nurses and pharmacists that interact with patients and stakeholders to ensure therapeutic success in a historically fragmented, manual process-driven model.
Challenges in specialty pharmacy operations
As with many aspects of the healthcare system, specialty pharmacy operations are fraught with many pragmatic, economic, and clinical care challenges.
Operational, pragmatic challenges include:
Multiple fax and phone communications between prescriber and specialty pharmacy supporting referrals, prescriptions, authorizations and patient care coordination
Challenging and fragmented patient engagement combining traditional phone-based communication with other methods such as texting with mixed results
Overlapping prescriber and patient communications among health plan, pharmaceutical manufacturer patient service hubs, prescribers and specialty pharmacy
These process challenges are creating an economic strain for the pharmaceutical industry, the payer, the provider, and most importantly the patient – where insurance benefit and funding source determinations often create confusion between overall coverage and patient out-of-pocket costs. This is compounded by complex coordination of benefits, billing and payment processing of medical and pharmacy claims, as well as other sponsored funding sources. Increasing patient cost share can make specialty drugs unaffordable for many patients which impacts medication adherence and ultimately patient outcomes.
The resulting clinical challenges make it difficult for critical patient care information to be easily shared (e.g. labs, patient assessments, medication profiles, side-effects, etc.). Additionally, treatment objectives often overlap among specialty pharmacy channel providers, resulting in crossed communications and patient confusion. In the end, key success metrics (both economic and clinical) are not easily measured, and often not operationally and clinically aligned.
The power of data accessibility and real-time analytics
Compressed specialty pharmacy margins require significant technology investment to offset operating costs and increasing service expectations. Technological advances help to address several of these challenges and as a result drive improvement in patient care and satisfaction, lower operating costs and more informed clinical decision-making.
Several of these technological advances that are showing early evidence of changing the historical paradigm include:
Interoperability with EHRs and other critical patient history data sources providing access to holistic views of patient medical records which can improve patient engagement, therapeutic interventions and reduce unnecessary procedures
Sophisticated workflow software driven by data-informed electronic protocols to support overall multi-party process efficiencies
Robust and timely analytics that provide comparative and predictive insights that influence optimal patient care at the lowest cost as well as provide more timely, accurate patient insights that drive patient success, including medication adherence
Integrated patient engagement technologies that improve patient interactions when and how the patient wishes to engage
Impact across the continuum
The application of advanced capabilities in connectivity and analytics in the specialty pharmacy space creates a more efficient system and a better result for all involved. Successful implementation of these technologies accelerates patients onto the most appropriate therapy, optimizes patient treatment plans and improves the overall patient experience which support medication adherence goals. It can also help establish innovative and more productive relationships between health plans, employers, providers, specialty pharmacies, pharmaceutical manufacturers and patients.