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Innovaccer Launches Integrated Provider and Pharmacy Quality Management and Reporting Solution for Health Plans
[May 30, 2024]

Innovaccer Launches Integrated Provider and Pharmacy Quality Management and Reporting Solution for Health Plans


Innovaccer Inc., a leading healthcare AI company, announced the launch of its quality management and reporting solution for health plans. The solution provides an NCQA-certified platform to help close care gaps and elevate quality ratings with end-to-end data ingestion, quality management, member engagement, and reporting. This launch follows Innovaccer's acquisition of PQS (Pharmacy Quality Solutions), a leader in pharmacy-payer performance technology, with the goal of accelerating value-based care in pharmacy settings.

Health plans have been challenged in their efforts to manage quality and reporting needs. The new quality management and reporting solution empowers health plans to streamline their processes and enhance member outcomes. By facilitating collaboration between providers and pharmacies with one integrated solution, payers can address care gaps more effectively, leading to improved quality scores and enhanced member satisfaction.

"Pharmacies have the largest number of touchpoints with members, and health plans' standalone efforts to engage proactively with their members are typically suboptimal," said Todd Sega, Managing Director - Pharmacy, Innovaccer. "The quality management and reporting solution is a game changer in this aspect. By improving collaboration between providers, payers, and pharmacies on an integrated platform, we can engage and improve member outreach, and close care gaps."

The solution supports health plan strategies to scale and succeed in an ever-evolving quality landscape and prepares them to succeed in a value-based care era. The solution features the following capabilities:

  • Unified data model: Built on USCDI and HL7/FHIR, the model ofers seamless integration for claims and clinical data management. With its highly auditable process and efficient onboarding, healthcare organizations can automate data ingestion and ensure data accuracy, streamlining their quality management processes.
  • NCQA-certified measure engine: A comprehensive set of certified quality measures and custom measure builds includes HEDIS®, Stars, QRS, and more. With over 245 certified measures and more than 700 custom measures, the solution supports various reporting requirements for efficient digital quality transition.
  • Gap closure engagement: With the integration of PQS, Innovaccer offers a diverse range of gap closure interfaces, providing multiple options to improve quality. The solution enables seamless provider engagement at the point of care, supported by an EHR-agnostic overlay and mobile/web portal options. Pharmacy engagement is optimized for identifying gap closure opportunities and reporting, leveraging Innovaccer tools.
  • Quality reporting: The integrated platform facilitates end-to-end processes for HEDIS®, IDSS, and PLD reporting across Hybrid, ECDS, and Admin Measures. This is backed with capabilities for record retrieval, abstraction, and review with an audit support dashboard.
  • Continuous quality management: Member-centric quality performance dashboards enable high-volume results. With an organizational hierarchy drill-down of measure performance and operational-level details for enterprise use, health plans can track performance against CMS Star Rating, QualityCompass benchmarks, custom targets, and build cohorts for outreach campaigns.



"With the addition of PQS to the Innovaccer family, we are taking a giant leap forward in our mission to transform healthcare through innovation," stated Abhinav Shashank, cofounder and CEO at Innovaccer. "The quality management and reporting solution marks the beginning of significant steps in advancing value-based care through data and AI. We're enhancing our ability to improve member health outcomes and establishing a seamless clinical data exchange with payers and pharmacies. Together, we're creating a connected ecosystem of payer, provider, and pharmacy, shaping the future of healthcare delivery."

To learn more about how our integrated provider and pharmacy Quality Management and Reporting Solution can help you close gaps in care, schedule a personalized demo with our healthcare experts and meet us at the RISE Qualipalooza 2024 on June 2-4, 2024.


About Innovaccer

Innovaccer is the data platform that accelerates care innovation through innovative AI technologies. Innovaccer's AI-powered healthcare platform unifies patient data across systems and care settings and empowers healthcare organizations with scalable, modern applications that improve clinical, financial, operational, and experiential outcomes. Innovaccer's EHR-agnostic solutions have been deployed across more than 1,600 hospitals and clinics in the US, enabling care delivery transformation for more than 96,000 clinicians, and helping providers work collaboratively with payers and life sciences companies. Innovaccer has helped its customers unify health records for more than 54 million people and generate over $1.5 billion in cumulative cost savings. The Innovaccer platform is an industry-leading data and analytics platform, the Best in KLAS CRM solution, and the #1 rated population health technology platform by Black Book. For more information, please visit innovaccer.com.


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