February 26, 2018
Under the Affordable Care Act (ACA or health care reform law), health plans are reaching out to members and doctors to make sure medical conditions are coded correctly and that they accurately reflect the true health status of members. Since 2014, Anthem has contracted with Inovalon to help with these outreach efforts. Outreach involves conducting health assessments with members in Individual and Small Group ACA plans, purchased on and off the health insurance exchange.
Who is Inovalon?
Inovalon is an independent company that provides secure, clinical documentation services to help make sure members get their diagnoses confirmed, corrected and updated each year. This review helps address potential preventive care gaps, like missed or overdue health screenings.
The goal is for members to have a health assessment every year and a complete, accurately coded claim submitted. If the member is seen annually and all chronic conditions are coded properly, gaps in care are closed, and prescriptions are renewed, then no further documentation is required.
What does Inovalon do?
Inovalon provides outreach efforts to doctors and members, on behalf of Anthem, when members have not had a health assessment or when their conditions are not coded properly. Some members receive a letter in the mail, others get a letter and an email. Some may also receive follow-up phone calls.
In these targeted communications, members are encouraged to see their primary care doctor or have a Personal Health Visit at a nearby retail clinic or in the member’s home. The Personal Health Visit does not replace care from the member’s doctor. Members may get a $100 incentive for the retail clinic visit or in-home assessment.
Inovalon is an Anthem partner. The email, letter or phone call members received from Inovalon is legitimate, and there is an incentive for scheduling a retail clinic visit or in-home evaluation.
For more information, members can call Inovalon at 1-800-390-3180.
Inovalon Members/Patients & Consumers
Inovalon is a cloud-based, analytics platform company empowering the healthcare ecosystem’s transition from volume to value. Our modular platforms leverage unparalleled proprietary datasets, advanced analytics, and data-driven intervention capabilities to assess and improve clinical & quality outcomes, utilization efficiency and financial performance. Payers, providers, pharma/life sciences, specialty pharmacy, and device manufacturers – all share the same need for data-driven insights to help drive meaningful business impact and improve care.
Member/patient engagement is integral for healthcare services payers and providers to be able to deliver the highest quality of care and promote preventive measures, while improving risk score accuracy and avoiding unnecessary costs. Inovalon offers an innovative member/patient engagement program driven by analytic insights that helps healthcare services payers and providers identify and engage members in an effective, targeted, and personalized manner to get them to complete a health assessment that helps close care gaps and improve care management, while promoting engagement and long-lasting relationships.