Analisa Flores

My Latest Work

Inovalon •

Mastering excellence: A guide to effectively benchmarking your healthcare quality metrics with monthly benchmarking data

Over $12 billion in performance incentives are offered yearly in the U.S. to health plans with top-quality scores. However, these scores are a constantly evolving target, influenced by the industry’s annual performance. This dynamic often leads to health plans misdirecting their efforts, as benchmarks shift in unexpected ways. Consequently, significant investments may yield minimal or no enhancement in healthcare quality metrics, and sometimes, scores may even decline.

Traditionally, health pla
Inovalon •

Illuminating healthcare: The impact of Medicare Advantage and Medicare Fee-for-Service on the quality of healthcare

In the ever-evolving landscape of healthcare, understanding the nuances of different care models is crucial. In the third part of our research series leveraging Inovalon’s comprehensive data assets and quality analytics capabilities, we have uncovered remarkable differences in the quality of care between Medicare Advantage (MA) and Medicare Fee-For-Service (FFS) programs.

This segment of our research collaboration with Harvard Medical School looks to answer the question: Does MA deliver better
Inovalon •

Driving value-based care success by empowering the health plan and provider relationship

Healthcare has embarked on a new era of value-based care success. Achieving value-based care success is dependent on building a strong partnership between health plans and their providers.

When creating these programs, there also has to be strong commitment and buy-in from your provider community. Simultaneously, health plans must ensure that the patient and their care is being kept at the forefront of any value-based care initiatives they’re looking to implement.

This blog explores the import
Inovalon •

2024 CMS Star Ratings: How better member targeting and intervention planning impacted plan performance

On October 13, 2023, the Centers for Medicare & Medicaid Services (CMS) released the 2024 Star Ratings for Medicare Advantage (MA) and Prescription Drug Plans (PDPs). Overall, plan performance for 2024 Star Ratings declined an average of .25 stars from 2023 ratings. This outcome was not a surprise given the cut point methodology changes (i.e., the Tukey methodology, a statistical method used for identifying outliers).

For 2024 Star Ratings, while lower measure performance was seen largely acros
Inovalon •

Advancements in Electronic Health Records: Navigating Machine Learning and Natural Language Processing Models

Both the Centers for Medicare & Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA) are placing a greater emphasis on the use of electronic data for quality measurement and improvement. CMS has been actively working on advancing quality measurement by transitioning all quality measures used in its reporting programs to digital quality measures (dQMs).1 This transition is part of a broader strategy to improve patient care and support the shift to dQMs over the coming y
Inovalon •

5 Challenges Inovalon's Electronic Record On Demand Can Eliminate

Though system adoption is large, obstacles still stand in the way of effective EHR use across the care continuum. For health plans, this can result in non-existent interoperability and data that is incomplete or fails to paint the patient picture.

Consider what is impacting your health plan and the benefits of deploying a well-rounded EHR system that encompasses seamless usability and safety, streamlined data entry, smooth coordination and communication, and effortless interoperability.
Inovalon •

Converged Provider Enablement

The Inovalon ONE® Platform allows UnitedHealthcare to seamlessly deploy and integrate Converged Provider Enablement with your existing Converged Risk and Quality software.

By implementing Inovalon’s advanced provider technology that combines, curates, and analyzes data, UnitedHealthcare can determine meaningful action, reduce administrative burden, and enhance transparency – resulting in measurable impact and success for both UnitedHealthcare and its providers.

Reduce the complexity of managin

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Easily support all your health plan’s quality measurement initiatives in one healthcare audit software solution that combines advanced analytics and detailed reporting. This means a better ability to meet tight reporting deadlines and ensure reporting accuracy, while also improving HEDIS® quality measures compliance and patient encounter documentation.


Built by industry experts and trusted by some of the nation’s largest health plans, Inovalon’s healthcare analytics tools and member engagem
Inovalon •

Inovalon Ranked #1 Payer Technology Solution

For the third consecutive year, Inovalon is proud to be recognized by Black Book Research as the top client-rated Payer technology for 2023.

This recognition reflects the industry’s confidence in our technology and our passion for being at the forefront of healthcare innovation and technology.

Following a customer survey including 143 solution providers, Black Book Research has once again recognized Inovalon as the Top-Ranked Cloud-based Data Platform for its robust data integration and predic
Inovalon •

Proactive CMS RADV compliance: Identify potentially over-coded conditions early on

Every year, the Centers for Medicare and Medicaid Services (CMS) conducts Medicare Advantage Risk Adjustment Data Validation (RADV) audits on Medicare Advantage (MA) plans to validate the accuracy and completeness of their data used in risk adjustment.

These audits can be intense and strenuous for MA plans due to the impact that accurate reporting of conditions has on risk adjustment payment. Depending on the MA plan’s validation rates, their risk adjustment factor (RAF) score can be negatively
Inovalon •

Optimizing medical record retrieval with healthcare data management

Healthcare data management can pose complex challenges for health plans. Depending on your current software, medical record retrieval can be inefficient and time-consuming. Plus, data quality and yield results vary from vendor to vendor, leading to inconsistent results and reconciliation efforts. This presents a serious problem for health plans because access to medical records is crucial for a myriad of reporting requirements.

Deploying software with vast medical record retrieval capabilities
Inovalon •

Buy or build? 4 crucial considerations for risk adjustment software decisions

Buying vs. building risk adjustment software. What’s right for you?

It is no secret that healthcare risk adjustment is an evolving landscape for all lines of business. As healthcare adapts to more and more developments in technology, finding and building software that is up-to-date and leveraging the latest technology is a smart choice for health plans.

Risk adjustment efforts play a critical role in determining appropriate reimbursement, improving patient care, and creating and establishing f
Inovalon •

The Importance of Medicare Advantage Plan Design: Financial Generosity, Coverage Design, and its Impact on Health Equity

Growing enrollment in Medicare Advantage (MA) over the past few decades has resulted in an expansion in the types of MA plans available to beneficiaries. The variety of Medicare plan designs has come partially through government policies like the Medicare Modernization Act.

Inovalon partnered with Harvard Medical School to understand the implications of various Medicare plan designs on who enrolls and on post-enrollment healthcare utilization and quality outcomes.

This final piece in our four-
Inovalon •

From Insight to Action: Lessons Learned at RISE National 2024

One of the biggest themes at RISE National 2024 was the need to cultivate trust through a culture of compliance. This trust has to manifest in a few different ways and areas of healthcare. Recent security breaches and the Department of Justice’s (DOJ) pleas to health plans to create trustworthy Medicare ecosystems highlighted just how necessary trust is moving forward.

Although RISE is known for its focus on risk adjustment, this year took an innovative turn by integrating sessions focused on q
Inovalon •

Inovalon Supports California’s Integrated Healthcare Association AMP Program

Leading healthcare analytics company supports IHA AMP reporting through its top-rated quality measurement and performance improvement solution

Inovalon, a leader in healthcare quality analytics, supports California value-based care plans through its top-rated quality measurement and improvement solution, Converged Quality, to support the California-based Integrated Healthcare Association’s Align. Measure. Perform. (AMP) Program. The AMP program is a value-based healthcare performance improvemen
Inovalon •

Why Inovalon Product Certification Matters

Gain more value with our new customer product certification programs

At Inovalon, we are committed to delivering the total customer experience. As part of this pledge, we are continuously growing the volume and range of product education, training, and support resources available through our Help Center and Learning Center to foster enhanced, high-value product experiences for our customers.

Most recently, our Payer Customer Success team introduced the launch of customer product certification
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