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Avalere Expands Analytic Offerings with Complete Suite of Medicare Claims Data


Today, Avalere announced that it has massively expanded its data and analytic capabilities through certification under the Centers for Medicare & Medicaid Services (CMS) Qualified Entity (QE) program.

As one of a few national QEs, Inovalon and Avalere (an Inovalon Company) now have access to patient-level data for Medicare Parts A, B, and D. This new stream of data compliments Inovalon’s existing MORE2 Registry┬«, one of the largest proprietary commercial datasets in the country.

What Is a QE?

To become a QE, organizations must meet precise requirements pertaining to performance measurement, data management, security and existing data volume to receive approval from CMS. Once this status is granted, a QE is given access to patient-level claims data for Medicare Parts A, B, and D. Inovalon is one of a few organizations in the US to have 50-state data.

How Can Providers Use This Data?

In the era of value-based care, providers are taking on more risk and need tools and resources to effectively manage the cost and quality of care for their patient population both within and outside of their walls. By having access to the full range of Medicare data, providers can gain greater insight into their patient populations, benchmark their performance, and improve patient care. They can also use this data to evaluate bundled payment programs and create new alternative payment models and other innovation programs.

How Can Health Plans Use This Data?

Health plans are under increasing pressure to provide access to the best care at the best price for their members. To support the drive towards value, these data can help health plans identify the best partners to engage in value based purchasing arrangements and quality improvement initiatives. This full scope of data can also help them map patient utilization patterns to support the development of care management programs to achieve better patient outcomes.

“We are now able to provide health plans with an expanded look into all parts of Medicare to support the development of networks, pharmaceutical and device outcomes-based contracting, underwriting of risk-based programs, and a variety of other mission-critical operations,” said Dan Mendelson, president at Avalere Health. “As we continue the shift toward value-based care, these data will help health plans and providers better manage their risk-based program performance and inform care management activities to support better patient outcomes.”

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