Healthcare Payer Solutions for Better Member Care

Automate payer workflows to improve outcomes and manage cost.

Agentic AI across risk adjustment, quality management, utilization management, and more to help health plans reduce manual work, improve decisions, and deliver better outcomes.

Smarter, faster decisions powered by unified data

Unified data turns fragmented payer information into actionable intelligence, helping health plans improve accuracy, accelerate performance, and support compliance across programs.

Maximize Financial Performance

Improve risk accuracy, close quality gaps, and reduce administrative spend with unified data and AI-driven automation.

Automate Decisions

AI agents support intake, evaluation, and communication so teams can focus on judgment, not manual work.

Stay Compliant with Confidence

Designed to support CMS, NCQA, and URAC requirements with audit-ready traceability at every step.

Risk Adjustment

Capture risk accurately and reduce manual effort.

Close HCC gaps and reduce audit risk with an AI-driven risk adjustment.

Quality Management

Close more care gaps and improve Star ratings.

Enhance Star ratings by closing care gaps faster with AI-powered quality management.

Utilization Management

Automate utilization management to approve faster, review smarter, and stay compliant.

Use AI-driven utilization management to reduce authorization costs, improve efficiency, and support more timely care decisions.

Automation that helps teams focus on what matters

AI across key payer programs.

AI agents support payer workflows to reduce manual effort and improve consistency across teams.

More accurate gap and opportunity detection.

Advanced analytics surface HCC gaps, quality opportunities, and authorization inefficiencies accurately.

Works with your existing systems.

Bi-directional integration with 200+ EHRs and existing payer systems, with no rip-and-replace required.

Scale without adding headcount

One unified data foundation across programs, with AI agents that scale as your volume grows.

Enterprise-grade security

HIPAA, HITRUST, and SOC 2 Type II certified to support enterprise healthcare operations.

Compliance and audit readiness

Designed to support CMS, NCQA, and accreditation requirements with full traceability at every step.

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.

Risk adjustment

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

Quality management

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

Care Management

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

Actuarial Intelligence

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

Leading Healthcare Organizations Choose Innovaccer

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

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.

Frequently Asked Questions

What are Innovaccer’s payer solutions?

Innovaccer’s payer solutions bring together connected capabilities for health plans across risk adjustment, quality management, utilization management, and more.

What workflows do they support?

They support payer workflows across data integration, coding, review, gap closure, authorization, communication, and reporting.

How do they improve performance and support compliance?

They help health plans reduce manual work, improve decisions, strengthen compliance, and maintain audit readiness through traceability, secure interoperability, transparent AI, and human oversight.