Healthy Patients Drive Healthy Margins
Innovista’s integrated, holistic health approach to value-based care delivers outcomes for providers, patients, and payers alike.
Value-Based Care Services
We help practices assess clinical and operational readiness, create effective strategies, and implement comprehensive programs to achieve success in the value-based care ecosystem.
A patient-centric approach to improving the overall health of patient populations
Serving members, families, and providers, we support treatment adherence and provide timely, cost-effective, quality care.
- Risk stratification
- High-risk/complex case management
- Transitional care/planning
- ER follow-up
- Social determinants of health screening
- Home visits
- Chronic disease management (asthma, diabetes, COPD, chronic heart failure)
- Medication adherence
- Quality measure gap closures
- Behavioral health
- Social services
Engaging and coaching physicians on how to succeed in value-based care
We aid physician groups by providing best-in-class service and innovative solutions to streamline processes.
Our provider relations teams act as a liaison between payer and ancillary providers to gather data, identify opportunities, and provide actionable insights that improve the quality and efficiency of care, while providing workflow resources to ease the burden on overworked practices.
Helping providers achieve the shared goal of member health while maximizing financial incentives
- Chart audits to identify care gaps
- Training to ensure accurate coding
- Reporting with actionable recommendations
- Root cause analysis
- Provider engagement and education
- Leveraging of annual wellness visit
Ensuring each patient is accurately coded to receive the best care
Risk adjustment ensures each patient is coded to the highest level of accuracy and specificity in order to predict costs and secure accurate funding.
- Risk adjustment coding gaps
- Full chart audits
- Coding revalidation
- Physician engagement and education
Interpreting payer, physician, and patient data into actionable insights to optimize performance
- Ingesting data from several sources into a normalized data structure
- Reporting to standardized benchmarks and market comparisons
- Identifying opportunities and trends
- Monitoring performance and quality improvements
Turnkey services to build, implement, and participate in multi-payer risk arrangements
Innovista analyzes contracts, identifies network requirements and provider performance, and works with clients to develop a network to exceed contractual requirements.
- Network assessment
- Development and contracting
- Facilities, specialists, post-acute, ancillary, site of service
Managed Administrative & Payment Services
Innovista provides a full suite of capabilities to support risk and non-risk payer arrangements to manage members, including network management, utilization management, eligibility, financial management, claims, and customer service.
Processing 1.7 million+ claims per year for clients
- Research, review, and adjudication of claims
- Claims auditing
- Provider appeals
- Physician, fee, code accuracy for network requirements
Delivering clinically necessary care; Processing 126,000+ referrals yearly
- Preferred network
- Medical necessity criteria
- Authorization determinations
- Denials
- Inpatient & outpatient referrals
- Pharmacology
Efficient support and facilitation for 175,000+ customer calls per year
- Physicians
- Patients
- Claims
- Referrals
- Authorization requests
Who We Serve
Physician Practices
$18.8M earned in value incentives annually for physicians succeeding in value-based care
Innovista supports doctors by identifying care gaps, supporting high-risk cases, improving attribution, and reducing unnecessary care. We also support practice managers and staff by connecting them with resources to optimize efficiency and workflow.
Payers
Access to 2,500+ primary care physicians engaged in value-based care
Innovista manages 61 unique payer contracts spanning Commercial, Medicare, and Medicaid lines of business. We help align care to cost, resulting in improved outcomes, predictable margins, and cost-effective care for members.
Patients
400,000 managed lives
Innovista supports patients by engaging family members in care planning and resource education. Through coordination of care, physician support, and greater access to resources, patients of Innovista clients enjoy higher quality of care at a lower cost. We achieve improved health outcomes by focusing on social determinants of health.
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HOSPICE & HOME HEALTH
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DIAGNOSTIC LABS
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REMOTE PATIENT MONITORING
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SKILLED NURSING FACILITIES
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COMMUNITY-BASED ORGANIZATIONS
Partners
Access to whole-person care in the community
Innovista partners with local health facilities and community-based organizations, ensuring patients have access to care where they live to support physical, behavioral, social, and financial health.
Where we serve
Illinois
Illinois is home to Innovista Health’s headquarters and 19 of the different medical groups and physician networks that it serves. The groups in this market range from small, independent IPAs to large hospital systems.
New Mexico
New Mexico is an emerging market for Innovista Health.
Texas
This market is served by a federation of independent ACOs with each group serving as its own governing entity. Our ACOs have a mission of improving patient care and lowering costs, especially for high-risk, low resource patients who are chronically underserved. We provide a revolutionary approach to value-based care centered on reducing the cost of high cost specialty care through mobilizing specialist teams in coordination with primary care teams.
Illinois
Illinois is home to Innovista Health’s headquarters and 19 of the different medical groups and physician networks that it serves. The groups in this market range from small, independent IPAs to large hospital systems.
New Mexico
New Mexico is an emerging market for Innovista Health.
Texas
This market is served by a federation of independent ACOs with each group serving as its own governing entity. Our ACOs have a mission of improving patient care and lowering costs, especially for high-risk, low resource patients who are chronically underserved. We provide a revolutionary approach to value-based care centered on reducing the cost of high cost specialty care through mobilizing specialist teams in coordination with primary care teams.
News & Resources
As more providers pivot to and embrace value-based care, their foremost concern is delivering the highest quality service to patients while using available resources appropriately. But they also have another priority that stays top of mind: ensuring their financial solvency under a new care model. Financial success requires a multi-faceted strategy, and accurate coding of services is a vital component. However, providers can’t protect their bottom line alone. They need help. Risk adjustment coders partner with practices to help them understand the importance of correctly using condition codes to estimate patients’ future healthcare costs. Hierarchical condition category (HCC) coding is
In value-based care, the reporting of data drives all decisions and actions. When practices do not have sufficient reporting material, or they do not fully leverage the analytical tools they have, they quickly learn what a challenge it can be to keep patients healthy and drive success in a value-based model. Reportable and actionable data management can be a challenge to many private practices. It consumes a lot of time and administrative resources to collect and analyze data so that providers can make informed healthcare decisions. Without back-end support to manage data, practices often fall behind, which leads to negative
Value-based care has a clear goal: to provide the highest-quality, most equitable patient care while controlling costs. As a growing number of hospitals and healthcare systems gravitate toward this care model, utilization management (UM) has emerged as a fundamental component to successful implementation. Doctors are well equipped to identify the services a patient needs, but they need a partner who can ensure patients receive those services in the right setting for the optimal price. This is where UM nurses step in to be that collaborator. UM nurses serve as a liaison between providers and payers. They review patient clinical records