Quality Analytics Suite
Quality rating and risk optimization improvements, driven by real-time insights
Quality teams generate comprehensive HEDIS reports and identify care gaps, yet these insights often live in spreadsheets, disconnected from the providers who can actually close them. For Medicare Advantage plans, this disconnect directly impacts Stars ratings and bonus payments.
The Puzzle
Why Quality Efforts Fall Short
When members, plans, and providers are in sync, everyone wins. Members receive more timely and targeted care; providers are better equipped to serve those members, and plans improve compliance and meet quality measure thresholds.
Yet, persistent data disconnects between quality, care management, risk adjustment, and encounter submissions can threaten to derail these improvements.
Siloed systems and manual operations amplify challenges and lead to lower Stars and HEDIS scores, missed care improvement opportunities and provider abrasion.
The Solution
How Invent Health Fixes It
Invent Health’s Quality Analytics Suite solves the quality-risk-care conundrum.
We deliver unified quality analytics and care gap closure insight in a single pane of glass.
Built to scale with your business and driven by advanced technologies, our Quality Analytics Suite ensures accurate revenue integrity, improved member outcomes, and continuous compliance.
In addition, FHIR/HL7 protocols form the backbone of our HIPAA and SOC 2 compliant approach.
Highlights
Key Capabilities
Invent Health delivers unified quality analytics and care gap closure insight in a single pane of glass.
Built to scale with your business and driven by advanced technologies, our Quality Analytics Suite ensures accurate revenue integrity, improved member outcomes and continuous compliance.
Quality Analytics Suite
Unified Risk + Quality Intelligence
- Consolidates diagnosis and quality gaps, utilization history, and predictive models into a single prioritization engine.
- Real-time surfacing, at the point of care, of members that impact both Stars ratings and risk adjustment factor (RAF) scores.
Quality Analytics Suite
Automated Quality Measurement & Compliance
- Real-time cut point monitoring, complete with early warnings on measures trending below thresholds.
- Automatic generation of supplemental submissions to augment audit trails.
Quality Analytics Suite
Advanced analytics-powered evidence extraction & electronic clinical data systems (ECDS) enablement
- Surface care gaps prior to appointment or during patient check-in.
- Enable nurse line, rooming staff, or clinician to act during the visit.
Quality Analytics Suite
Intelligent Gap Closure & Member Targeting
- Outreach, scheduling, and follow-up are prioritized based on impact, not guesswork.
- Real-time gap updates show which efforts are effective and where resources should shift.
Quality Analytics Suite
Quality Insights Dashboard & Operational Intelligence
- Real-time dashboards provide visibility into Stars, HEDIS, risk, provider performance, and gap trends.
- Encounter quality and documentation monitoring reduce coding errors and support compliance.
How It Works
The Invent Health Quality Analytics Suite enables health plans and provider organizations to proactively measure, monitor, and improve clinical quality performance.
Integrating claims, EMR, and encounter data automates HEDIS®/Stars® computation, detects quality gaps, and supports evidence extraction for faster closure and compliance.
Builds a unified member profile by continuously ingesting and normalizing data from APIs, EMRs, FHIR/claims pipelines and supplemental resources.
Calculate open gaps and condition opportunities in real time by applying HEDIS, Stars and risk adjustment impact logic.
Rank members and providers by expected impact using combined quality, risk, utilization, and performance signals.
Automatically extract, verify, and match clinical evidence to open gaps enabling auditable, compliant closure for quality and risk programs.
Deliver real-time Stars, RAF, provider, and gap insights through dynamic dashboards, enabling immediate action and continuous improvement.
Who It’s For
Health Plans Seeking a Unified Risk & Quality View
Provider Groups, IPAs & Health Systems
ACO REACH, DSNP & Managed Medicaid Programs
Quality Improvement, Care Management & Population Health Teams
Industry Best Practices We Support
Outcomes Delivered
The Invent Health Quality Analytics Suite delivers measurable financial, clinical, and operational improvements and demonstrable impact—mapped directly to the KPIs health plan and provider executive track.
| Executive KPI | Value Delivered by Invent Health | Outcome / ROI |
|---|---|---|
| Stars & HEDIS Performance | Real-time Stars/HEDIS dashboards, predictive alerts, EMR-embedded gaps | Higher Stars ratings, faster cut-point attainment |
| Gap Closure Rate & Speed | Pre-visit + point-of-care gap surfacing | 50–60%+ closure, shorter time-to-close |
| RAF Accuracy & Recapture | AI-powered evidence extraction + coder validation | More accurate RAF, higher recapture, lower audit risk |
| Resource Prioritization | Prioritization engine surfaces high-impact members/providers | 2–3× efficiency gain with targeted outreach |
| Financial ROI & Revenue Lift | Real-time RAF/Stars revenue modeling + ROI tracking | $30–$80 PMPM revenue lift or protection |
| Provider Adoption & Experience | Embedded EMR workflows reduce friction | Higher provider participation, more complete visits |
| Operational Efficiency | Automated supplemental submissions + evidence extraction | 30–40% reduction in admin burden |
| Audit Readiness & Compliance | Structured audit trails + validated evidence | Higher supplemental acceptance, stronger compliance posture |
Key values Definitions
| Category | Challenge | Invent Health Value | Executive Outcome |
|---|---|---|---|
| Quality Performance (Stars/HEDIS) | Fragmented reporting leads to late measure recovery | Real-time dashboards + predictive cut-point alerts | Improved Stars ratings & earlier cut-point attainment |
| Gap Closure Performance | Low closure rates due to delayed data | Pre-visit & visit-level gap surfacing | 50–60%+ gap closure, faster completion cycles |
| Risk Adjustment (RAF Accuracy) | Missing documentation lowers RAF accuracy | AI-driven evidence extraction + coder review | More accurate RAF scores, reduced audit exposure |
| Prioritization & Efficiency | Teams chase lower-value members | Prioritization engine targets high-impact members/providers | 2–3× efficiency gains |
| Financial Performance | No visibility into revenue impact of quality/risk efforts | Real-time RAF/Stars ROI modeling & attribution | $30–$80 PMPM revenue lift or protection |
| Provider Experience | Multiple portals create friction & low adoption | EMR-integrated workflows & clear provider insights | Higher adoption & more complete visits |
| Operational Execution | Manual supplemental submissions & chart review | Automated evidence extraction & submission | 30–40% reduction in administrative workload |
| Compliance & Audit Readiness | Documentation gaps, inconsistent supplemental acceptance | Structured audit trails, validated evidence, automated submission | Higher compliance & supplemental acceptance |
Contact us
Make Every Provider Visit Count
Invent Health delivers actionable risk and intervention gap insights directly into care workflows while improving Stars and HEDIS scores.
