Healthcare Payer Solutions for Better Member Care
Powering Payers with intelligence to improve outcomes & cost
Innovaccer helps payers transform fragmented data into actionable intelligence—reducing costs, improving outcomes, and accelerating compliance in an increasingly complex healthcare landscape.
Smarter, faster decisions powered by unified data, AI-driven insights, and payer-first design
Innovaccer helps payers cut costs, close gaps, and drive performance with AI-powered insights and a unified data platform built for health plans.
Maximize financial performance
Leverage unified analytics and AI to reduce medical loss ratios, optimize reimbursements, and proactively manage risk.
Drive operational efficiency
Simplify workflows, eliminate data silos, and enable faster, more accurate decision-making across teams and departments.
Stay ahead of regulatory demands
Ensure ongoing compliance with HEDIS, CMS, and NCQA guidelines while streamlining audits and reporting with built-in regulatory intelligence.
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Ensure ongoing compliance with HEDIS, CMS, and NCQA guidelines while streamlining audits and reporting with built-in regulatory intelligence.
Healthcare Intelligence for Payers
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.
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.
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.
All powered by the Data Activation Platform
Labs
Pharmacy
Claims
EMRs
SdoH
Consumer & Digital Health
Third-party Data
Steps of 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
Patient & provider information are aggregated into a single record.
3X more accurate than off-the-shelf AI
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.
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.
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.
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, risk and social vulnerability profiles, gaps in care, engagement data, next best actions, and more.
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.
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.
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