Collaboration Between Inovalon and Amazon Web Services to Use AI/ML to Improve Healthcare

 Large training datasets, enhanced logical scaffolding, and advanced AI/ML hold significant promise for improved performance.

October 17, 2023 (GLOBE NEWSWIRE) -- BOWIE, Md. At its annual Customer Congress conference in Washington, D.C., Inovalon, a top provider of cloud-based software enabling data-driven healthcare, announced a partnership with Amazon Web Services (AWS) to create superior software solutions to support the healthcare sector's pursuit of better outcomes and economics. When compared to previously available technologies, the combination of AWS' Artificial Intelligence (AI) products—including Amazon Comprehend Medical— is further enhanced through the application of logical scaffolding informed by Inovalon's AI/machine learning (ML) capabilities and deep subject matter expertise is producing superior results.

 

The Company's SaaS-based software platform, Inovalon ONE®, which supports more than 20,000 customer organizations throughout the healthcare ecosystem, is being expanded to provide collaborative capabilities for a variety of applications. Today at Inovalon's Customer Congress, demonstrations of next-generation technologies that will increase the accuracy of risk scores for health plans will be given.

For the most part, health plans rely on medical records and insurance claims to calculate the disease burden, or risk score, of the people in their managed populations. The use of suitable resources to meet members' healthcare requirements as well as precise payments and reimbursements are then informed by this risk score. Sadly, there are important gaps in the understanding of patient disease condition, development, and treatment requirements, as well as improper payments and reimbursements, between medical documentation and claims data. As a result, health plans spend a lot of money trying to validate and comprehend the risk scores of their members.

Even though the healthcare sector has used Natural Language Processing (NLP) technologies to help with the collection and analysis of risk score data, the sector's current NLP solutions struggle to extract important data points from the medical records without having a disproportionately high false positive rate. A doctor, a reviewer of medical records, or an auditor cannot accurately locate a potential problem area within a patient's case documentation using the solutions of today. 

As a result, risk scores are less accurate, individual patients' disease status and care needs are less understood, initiatives to increase accuracy are more expensive, and health plans are at higher risk of accidentally submitting inaccurate risk score data that could expose them to liability and financial penalties.

AWS's Amazon Comprehend Medical® NLP service is used by the NLP/ML-powered application that Inovalon is jointly developing to extract insights from unstructured clinical literature and map clinical concepts to standardized medical codes like ICD10-CM. Comprehend Medical's enhanced output is integrated with a logical scaffolding developed using Inovalon's AI/ML capabilities and in-depth domain knowledge. The end result is an upgraded capability to evaluate the medical records of targeted members to find those that are very likely to have significant discrepancies between clinical documentation and claims data related to the patient.

 

The solution can also pinpoint the location of the evidence that supports a concern in addition to calculating the likelihood that these disconnects are statistical true positives. As a result, a solution that enhances claim review efficiency and lowers costs by providing users with valuable insights and patient-level data has been enhanced with more accurate risk scores. Early in 2024, according to Inovalon, the application should be generally accessible.

Eron Kelly, president of Inovalon, said, "Our focus is on the constant improvement of the Inovalon ONE Platform so that we can in turn empower our customers to achieve their missions." "This is the first of several collaborations we are doing with AWS to empower our customers to improve healthcare outcomes and economics through the thoughtful and careful use of AI/ML."

"AWS's expertise in the practical use of AI/ML technologies alongside Inovalon's leadership in healthcare data and analytics can help deliver more efficient and accurate healthcare applications," stated Tehsin Syed, GM of AWS's "Medical documentation and claim review solutions built with these technologies can offer health plans a wide range of benefits, including reduced effort and cost." 

Regarding Inovalon

A leading supplier of cloud-based software solutions enabling data-driven healthcare is Inovalon. A complex cloud-based platform, the Inovalon ONE® Platform combines national-scale connectivity, real-time primary source data access, and powerful analytics to enable better outcomes and economics throughout the healthcare ecosystem. The primary source data of more than 79 billion medical events spanning one million doctors, 654,000 clinical settings, and 375 million unique patients informs the company's analytics and capabilities, which are used by more than 20,000 customers. To learn more, go to www.inovalon.com.