BOWIE, Md., Oct. 17, 2023 (GLOBE NEWSWIRE) -- Inovalon, a leading provider of cloud-based software empowering data-driven healthcare, announced at its annual Customer Congress event in Washington, D.C. a collaboration with Amazon Web Services (AWS) to develop superior software solutions to support the healthcare industry’s pursuit of better outcomes and economics. The combination of AWS’ Artificial Intelligence (AI) products, including Amazon Comprehend Medical, further enhanced through the application of logical scaffolding informed by Inovalon’s AI/machine learning (ML) capabilities and deep subject matter expertise is yielding superior results when compared to previously available technologies. 

The collaborated capabilities are being developed for multiple applications across the broader Inovalon ONE® Platform, the Company’s SaaS-based software platform supporting more than 20,000 customer organizations across the healthcare ecosystem. Demonstrations being provided today at Inovalon’s Customer Congress event include a next-generation capability pertaining to health plan risk score accuracy improvement software.

Health plans primarily depend upon medical documentation and medical claims to determine the disease burden, or risk score, of the members of their managed populations. This risk score is then utilized to inform the application of appropriate resources to support members’ health care needs as well as accurate payments and reimbursements. Unfortunately, meaningful disconnects exist between medical documentation and claims data resulting in an incomplete understanding of patient disease status, progression, and care needs, as well as inaccurate payments and reimbursements. As a result, health plans expend significant resources to more accurately understand and substantiate their members’ risks scores.

While Natural Language Processing (NLP) technologies have been applied within the healthcare industry to aid in the capture and analysis of risk score information, the industry’s currently available NLP solutions struggle to tease out key data points from the medical records without an extremely high false positive rate. Further, today’s solutions fail to provide meaningful targeting insight to guide a clinician, medical record reviewer, or auditor to precisely where an area of concern within a patient’s case documentation may lie. The net result is lower accuracy within risk scores, lower understanding of individual patient’s disease status and care needs, higher costs related to accuracy-improving initiatives, and greater risk to health plans with respect to their inadvertent submission of inaccurate risk score data which can lead to potential legal liability and financial penalties.

The NLP/ML powered application being developed collaboratively by Inovalon leverages AWS’s Amazon Comprehend Medical® NLP service to derive insights from unstructured clinical text and map clinical concepts to standardized medical codes like ICD10-CM. The enriched output from Comprehend Medical is combined with a logical scaffolding created from Inovalon’s AI/ML capabilities and deep subject matter expertise. The result is an advanced capability to analyze targeted member medical records to identify those that are highly likely to have meaningful disconnects between the clinical documentation and that of the claims data associated with the patient. Additionally, the solution not only is able to determine the probability of such disconnects being statistical true positives, but also highlight where the evidence which supported a concern resides. The result is a solution that empowers users with powerful insights and enriched patient-level data with greater risk score accuracy to augment claim review efficiency and decrease costs. Inovalon expects the application to be generally available early in 2024.

“Our focus is on the relentless enhancement of the Inovalon ONE Platform so that we can in turn empower our customers to achieve their missions,” said Eron Kelly, President of Inovalon. “This is the first of several collaborations we are doing with AWS to empower our customers to improve healthcare outcomes and economics through the thoughtful and careful use of AI/ML.”

“AWS’s expertise in the practical use of AI/ML technologies alongside Inovalon’s leadership in healthcare data and analytics can help deliver more efficient and accurate healthcare applications,” said Tehsin Syed, GM Health AI, AWS. “Medical documentation and claim review solutions built with these technologies can offer health plans a wide range of benefits, including reduced effort and cost.” 

About Inovalon
Inovalon is a leading provider of cloud-based software solutions empowering data-driven healthcare. The Inovalon ONE® Platform brings together national-scale connectivity, real-time primary source data access, and advanced analytics into a sophisticated cloud-based platform empowering improved outcomes and economics across the healthcare ecosystem. The company’s analytics and capabilities are used by more than 20,000 customers and are informed by the primary source data of more than 79 billion medical events across one million physicians, 654,000 clinical settings, and 375 million unique patients. For more information, visit www.inovalon.com. 

Contact: Glen.Brandow@inovalon.com
              Senior Director, Corporate Communications