For Payers

Clean and complete clinical data is the key to predicting outcomes

Verinovum’s Data Curation as a Service (DCaaS) is focused on the use cases most important to your organization: the ones that will help you unlock clear pathways to improved quality measures, better identify and target members for disease management and wellness programming, identify fraud, waste, and abuse, and avoid unnecessary costs. Our platform offers a fast, secure, scalable curation and enrichment solution to the complex, convolutedand often hidden problem of low quality, hard-to-get clinical data. 

Helping you streamline your workload

Realize member savings with complete data fueling your disease management efforts.

Reduce administrative costs and time to acquire clinical data.

Feed business decisions with clean clinical data.

Get more out of your population health programs.

Build a reliable foundation for value-based activities.

Vastly improve the accuracy of quality measures.

We’ve built a bridge that provides a clear pathway to reliable clinical data.

  • Enables data sharing between payers and providers.

  • Alleviates the burden of segmenting and transmitting data by payer roster.

  • Streamlines integration of clinical information.


We don’t try to boil the whole ocean of data. Instead, we focus on the most prolific and devastating diseases and conditions. With fully curated data sets around uses cases such as diabetes, you can extend the reach and impact of your disease management programming and improve your quality measures.

Data Curation as a Service (DCaaS) data modules

Chronic Care


Nearly 1 in 3 adult Americans have high cholesterol, putting them at at risk for heart disease and stroke, the two leading causes of death in the U.S.  In 2010 the CDC estimated the economic costs of cardiovascular diseases and stroke to be $444.2 billion, including $272.5 billion in direct medical costs.and $171.7 billion in indirect costs. Complete, curated, and enriched clinical data can help you better identify which members need disease management programming,  support ongoing communication, and identify enrollment abuses and fraud.

Quality Measures:

  • NQF – 0611 

Blood Pressure

About one in three U.S. adults, or about 75 million people, have high blood pressure. A person with hypertension is four times more likely to die from a stroke and three times more likely to die of heart disease. Those with uncontrolled high blood pressure tend to have almost $2,000 in added annual medical costs than those patients whose blood pressure is under control. With complete, reliable clinical data set on your hypertensive population, you can better target disease management programming, improve quality measures, and reduce unnecessary costs.

Quality Measures:

  • Star Ratings – DMC17
  • NQF – 0018


People with congestive heart failure (CHF) tend to see poor health-related quality of life as their disease progresses, and, with a tendency to have multiple co-morbidities, are at increased risk of multiple hospitalizations. That has a big impact on their quality of life and your quality measure scores. With Verinovum, you can better identify members with gaps in care or at risk of re-hospitalization, and intervene in a timely manner.

Quality Measures:

  • NQF – 2886, 0081e, 0083e, 0071 


COPD is the third most common cause of death. The COPD patient population costs increase with the severity of the disease  – medications, equipment, and hospitalization – with a difference of at least $5,000 between each stage. With Verinovum, you can better identify and stratify members with COPD for disease management and outreach, support verification of ongoing communication with members and providers with a gap in COPD care, trend the progress of COPD FEV1 results alongside medication types and adherence at the individual member level, and much more.

Quality Measures:

  • NQF – 0091, 0102


Asthma tends to exist as a lifelong condition with varying degrees of severity throughout the person’s life. Often, reliance on rescue medications and expensive ER visits resulting from failure to adhere to medication and treatment regimens means inefficiencies that may be avoided with the help of disease management programs. Having at-the-ready, complete, and reliable data can help you identify patterns and issues among the population you serve, helping you improve adherence and member health at the individual level.

Quality Measures:

  • NQF – 1799, 1800 

Weight Management

The trend of overweight and obesity is not letting up in the U.S., and is a risk factor in a variety of diseases, including COVID-19. Your members who are overweight or obese tend to have higher utilization, incur greater costs and are more prone to costly diseases. With Verinovum, you can better identify and stratify members with higher BMI for weight management programming, support verification of ongoing communication between providers and members with a gap in care, and improve quality measures.

Quality Measures:

  • Star Ratings – C07
  • NQF – 0024, 0421e


People with cancer deserve the best support you can give as a payer. And those who are not yet diagnosed sometimes have worse – and much more costly – outcomes when early detection and screening efforts fall through the cracks because of incomplete and missing data. You are a critical part of a cancer patient’s care team. With Verinovum, you can get up-to-the minute, reliable clinical information information to help inform better outcomes.

Quality Measures:

  • NQF – 0383, 0384e, 0389e


Diabetes is the seventh leading cause of death in the U.S. and affects about 10.5% of American adults. While advancements in treatments have provided high-impact, effective new therapies, treatment has not gotten less expensive. According to the American Diabetes Association in 2017, diabetes cost the U.S. an estimated $327 billion ($237 billion in direct medical costs). When you have the most up to date and reliable information at the ready, you can better communicate with and support your member population.

Quality Measures:

  • Star Ratings: C13, C14, C15;
  • NQF – 0055, 0056, 0059, 0062, 0066, 0089e, 0416, 0417, 2887

Mental Health

Mental health issues as depression and anxiety are on the rise in the United States. At some point in their lifetime, nearly half of Americans will experience some form of mental health issue. Costly ER visits with mental health problems as the primary reason reached 4.8 million in 2017 alone. Those diagnosed with mental health issues may require more care, medication, and healthcare touchpoints. For those undiagnosed, early intervention is critical and behavioral support programming can go a long way. Wither Verinovum, you’ll get the right information to help your affected members best.

Quality Measures:

  • NQF – 0110, 0418e, 0710e, 0711, 0712e

Preventative Care


Perhaps no preventive action is simpler than staying up-to-date on routine immunizations, for adults and children. People who do not get vaccinations, whether by personal choice or, more often, a missed or unrecorded immunization, can wind up facing dire health consequences that could affect others as well. With the right data, you can stay abreast of how the population you serve is faring, and stem preventable costs from diseases we have solutions for.

Quality Measures:

  • NQF – 0038, 0041e, 1407


Expectant moms who don’t have pre-natal care are at risk of costly complications. Meanwhile children are at greater risk of low birthweight and other problems that could be lifelong. Knowing who is getting prenatal care and how early in the pregnancy it began is key to improving outcomes and controlling costs for mother and baby. With Verinovum’s platform, you’ll have complete, reliable data you can count on to help ensure your members and their future family members are getting the care they need.

Quality Measures:

  • NQF – 1391, 1517 

Medication Management

About 66% of the U.S. adult population takes some sort of prescription medication. It’s an area fraught with potential challenges: Medication adherence, drug interactions, proper dosing, patterns of abuse. Getting your data in control can provide an antidote to those issues by giving you clean, reliable data to look at trends across your member population, to identify medications without corresponding claims, and to reduce duplicative and unnecessary costs.

Quality Measures:

  • Star Ratings – C09, C19
  • NQF – 0022, 0068, 0097, 0105, 0108, 0419e, 0553, 1879

Special Needs Plans

Medicare Advantage created plans specifically for those with special needs. The plans are aimed at reducing lost revenue and added expenses for those patient populations, and better helping them through what they need. Verinovum’s Data Curation as a Service (DCaaS) offering maximizes the value of clinical data assets to support those business objectives and drive associated value.

Treatment Medication Analysis

Treatment/Medication Analysis tends to be lacking because of  competing priorities and limited resources. But that can result in lost revenue and increased expenses from duplicate screenings, testing, imaging, “chart chasing,” and more. Getting your data in control can help remedy these negative trends. Verinovum’s Data Curation as a Service (DCaaS) offering maximizes the value of clinical data assets to support the business and drive associated value.

The impact of curated and enriched data

When we improve the quality of your usable data, you discover new opportunities. Verinovum’s curation and enrichment process improved one client’s usable clinical data from 14% before curation to 89% usable afterwards.

Usable Data


Usable Data
(Curated & Enriched)


Overall Lab Results:


63% more labs formed and coded

Cardiology Lab Results:


70% more cardiology labs codes


63% more cardiology results codes



56% more mammogram codes uncovered

Source: Independently verified Verinovum study in July 2018 on behalf of a major plan which included a sample of 55 clinical locations.

“Successful deployment of a comprehensive health data curation and enrichment hub, like Verinovum, is a foundational component of the real-time health system, conducting digital healthcare, and the ability to execute population health and community care management”

Gartner Hype Cycle Report, August, 2018

Intrigued? Learn more about what we can do for you.


Data Curation as a Service (DCaaS) Solution





Let’s discuss your business’ most pressing data-related challenges

Request a consultation