Case Study: Aetna improves star ratings and care outcomes with Inovalon Converged Quality

Aetna improves star ratings with Inovalon, boosting 57% of 5-star plans

Aetna, a national health plan serving over 22 million members, faced the challenge of meeting complex regulatory benchmarks and improving healthcare outcomes. They needed to simplify HEDIS and star ratings reporting, accelerate the identification and closure of member care gaps, and ensure accurate data documentation. To address this, Aetna turned to the vendor Inovalon and its Converged Quality solution.

By implementing Inovalon's Converged Quality software, Aetna gained real-time insights to pinpoint care gaps and launch timely interventions. This solution from Inovalon provided enhanced data accuracy and processing speed, enabling more proactive member engagement. As a result, Aetna was one of the few national plans to see a strong improvement in its star ratings, with a 5% increase over the national average. The implementation also led to enhanced member outcomes and reduced future healthcare costs through preventative care.

Aetna