The growth of Medicare Advantage (MA) plans is among one of the many challenges health plans face as they aim to optimize member care while maintaining high-quality compliance standards.

A Midwest America-based ACO spread across 70 locations of six regional chapters had 18+ value-based contracts with over 325,000 covered lives. With over 190 participant organizations and 3,600 providers, the ACO deployed Innovaccer’s Data Activation Platform and its analytics module, InGraph.

A leading CIN based out of Nebraska deployed InConnect to unburden its care teams from manual patient outreach. They needed a solution to plug care gaps and improve the patient experience. With InConnect, the CIN was able to reach out to a broader set of patients and educate them on the go.

An ACO with over 165 physicians based in the Western US had more than 50,000 Medicare lives and 110,000 commercial lives attributed to them on 5+ value-based contracts. The patient data was distributed across 6 different brands of EHRs at more than 24 practices along with labs, pharmacies, and claims.

Spread across 65 practices in Texas, the ACO was engaged with five national and commercial payers, looking after more than 200,000 patients. With data incoming from EHRs at 60+ practices, over 280 physicians, and three labs, the ACO required a holistic view of population health.

A leading Iowa-based PHSO sought to reduce its overall healthcare expenditures by optimizing its skilled nursing facility (SNF) utilization and costs across the network. Increases in the average length of stay (LOS) and daily charges meant utilization reimbursements varied, and the PHSO struggled to deliver cost-effective care.

One of the nation’s largest healthcare systems approached Innovaccer with the goal of improving its care management technology. Its mission is to provide high-quality, cost-effective care to enhance community health. It operates in 19 states and is comprised of 105 hospitals, including four academic medical centers and teaching hospitals; 30 critical access facilities; community health services organizations; accredited nursing colleges; and home health agencies; and other services.

Over the past decade, payers and providers have made significant improvements in the safety, effectiveness, and efficiency of medical care, and the shift to member-centered, value-based care models has only increased the need to deliver high-quality care.

Members are at the core of any health plan. However, the aftermath of COVID-19 poses new challenges for payer organizations when it comes to member enrollment.

Payer compliance deadlines for the CMS Interoperability and Patient Access final rule are fast-approaching. The rule, which CMS hopes will create industry-wide, barrier-free data exchange, will require payers to give patients easier access to their healthcare data as well as implement provider directory APIs that third-party programmers can use to create applications for members. In addition to true data transparency, the rule will help payers leverage data to identify gaps in care, execute timely interventions, and get new insights for population health management.