Data-Driven Provider
Engagement Solutions

Care Gap Management

Novillus is your experienced partner providing the technology and provider engagement expertise to help you manage the ‘care gap’ lifecycle and optimize outcomes for your population health, Medicare Star Ratings, Medicaid and Risk Adjustment programs. Our payer-specific, customizable care gap management solution helps you identify opportunities and close member care gaps.

Key Outcomes Include:
  • Increased engagement with independent and provider-employed physicians
  • Improved care delivery and workflow models that align incentives and reduce care costs
  • Improved provider and member satisfaction
  • Enabled population management tools and services at the point of care for multiple populations
  • Educated provider network with varied readiness for accountable care
  • 4+ Medicare Star Ratings for health plan partners

Care Gap Management
Product Guide

Novillus offers our clients a comprehensive solution for care gap management and overall quality management. We help Medicare, Medicaid, Commercial, CHIP and ACA payers improve clinical quality, operational, and patient satisfaction-related Medicare Star Ratings, HEDIS® and Part D measures. Our Quality Management solution includes technology tools, physician and member engagement expertise and incentive design/consulting services.

All payers and providers need technology tools that measure and increase performance at the enterprise, population and patient level. Novillus provides powerful, yet easy to use care coordination tools to help payers and providers manage their populations, as well as address measures with each individual patient.

Tools Include:
patient worklist

Patient Worklist – Shows all needed interventions for a population of patients, filterable by risk, disease-states or by physician or facility (cohorts and client-specific programs), allowing the prioritization by a number of factors, including treatment by severity and need for outreach.

patient care

Patient Care Profile – Provides the patient care gaps, risk score and clinical and claims-level details regarding recent physician visits, ER visits, acute admissions, diagnoses, procedures, imaging tests, laboratory tests, preventive care screenings,

kpi dashboard

KPI Dashboard – Displays clinical quality measure key performance indicators and trends over time and real-time current status, with optional incentive performance status

measure summary

Measure Summary Table – Displays clinical quality measures used in evaluating performance among different populations

content library

Content Library – The digital content library provides information on disease states, documentation and coding for clinical decision support. The platform helps payers identify providers who need support managing their populations. It helps providers identify patients most likely to benefit from a targeted intervention, emphasizes quality considerations at every interaction and captures essential information key to Star ratings and HEDIS measures.

Provider Group Engagement

Novillus uses deep, multi-channel engagement experience to help payers build collaborative and consultative relationships with provider groups. We understand that an important success factor in building these relationships is aligned incentives. Our robust provider group engagement playbook empowers plans and providers to create a lasting impact on clinical quality metrics and patient satisfaction.

physician engagement
Features Include:

Comprehensive education resources that help providers learn about Star ratings and quality metrics, correct coding practice, and the use of Novillus’ user-friendly web application to close gaps in care and change behavior to improve Star ratings

Provider group performance management, including aligning contract incentives, monitoring compliance, highlighting opportunities to resolve gaps in care, and selecting metrics for cumulative improvement of Star Ratings, quality measures and Risk Adjustment outcomes

Consultative provider group engagement, including outreach coordination, industry best-practice sharing, and input on plan decisions


The Novillus care gap management solution puts actionable, real-time power into the hands of providers. Unleashing these provider actions creates opportunities for faster analysis of emerging trends that directly impact your performance goals.

Insights is the Novillus analytics power tool that compliments the care gap management solution to harness provider actions into clearly understandable visualizations. Armed with decision support information powered by Insights, you’ll be able to take decisive actions reach or exceed your performance goals.


Provider Directory Accuracy

Our provider directory information accuracy solution, Novillus Clean, will quickly and efficiently power your provider directory with 100% accurate data. We use an innovative combination of provider group engagement best practices, direct marketing expertise, data hygiene methodologies, research and verification—all developed over years of acquiring and maintaining accurate provider directory data to ensure your provider directory is compliant with Federal regulations in the No Surprises Act associated with the Consolidated Appropriations Act of 2021.

A recent health plan audit highlights the provider directory data accuracy problem:

43% of providers were not participating in the health plan at the listed location and could not offer appointments and 35% of providers could not be found at the location listed

50% of the dermatologists were duplicates and only 26% of the total were at the listed address, accepted the members from the plan, and had available appointments

Our Clean solution platform makes implementation straightforward, fast and secure. We can have you compliant in weeks rather than months.

Fully Managed Turnkey Solution

Novillus Clean is a fully managed, flexible, turnkey solution directory data solution that provides 100% continuously verified provider data. We will ensure that your provider directory data is accurate and up-to-date to meet Centers for Medicare and Medicaid Services (CMS) compliance requirements. We manage the entire cleaning process for you, freeing up your health plan resources to focus on other priorities.

Focused On Provider Data

Unlike traditional data services that try to cater to many vertical data needs, we are singularly focused on delivering the most accurate and up-to-date provider directory data possible.

We don’t scrape data or buy it from 3rd parties. Our unique, innovative process gets accurate data directly from the source: provider contacts. And we have the feedback data to prove that providers actually enjoy the experience.

Great Provider Experience

Our solution gives providers an elegant, simple, fast user experience during the outreach process for provider directory data updates. And we have the provider feedback metrics to prove it. This has a measurable, positive benefit to your plan’s brand.

Accuracy You Can Count On

Novillus Clean delivers accurate, continuously verified provider directory data through a combination of industry best practices, direct marketing expertise, leading data hygiene methodologies, research and verification—all developed over years of acquiring and maintaining provider directory data.

Understanding and documenting all the practitioner and provider group relationships in the real world is very challenging. Providers and their relationships to one or more provider groups – all the site locations – and the hours of operation at each location can be very complex. And these relationships can change often. Our innovative process obtains and maintains accurate information on these complex relationships that cannot be matched by other solutions.

Easy To Integrate

Our leading-edge solution platform, web services and configurable data management capabilities makes data integration to your provider directory straightforward, fast and secure. Ease of integration is one of the key reasons that Novillus Clean can have your provider directory compliant in a matter of weeks rather than months.

Strategic Consulting and Support Services

In addition to our innovative technology solutions, Novillus offers client partners strategic support to help them achieve their program and performance goals. Our team of experts come from various health plans across the country with the knowledge and tactical experience to improve performance for HEDIS®, Medicare Star Ratings, Risk Adjustment / Hierarchical Condition Category (HCC) capture, product design, and data quality and architecture. Our team is available to serve on a project basis or as interim full-time support.

Novillus is equipped with a team of certified risk adjustment and HEDIS quality coders to augment health plan resources. Additionally, Novillus has enabled a complete CRM solution with outbound/inbound capabilities to support health plan campaigns and initiatives.


Calculus is a powerful tool for modeling and managing provider performance in Medicare Advantage, Medicaid, CHIP, ACA and value-based contracting programs. Calculus can calculate provider performance and incentives on a daily basis over a range of different reward programs. Model-building tools help you create and try out “what if” provider incentive reward packages and generate financial forecasts; using Calculus trend analysis you can then tie the actual results back to the forecasts. Calculus makes it easy to manage provider incentive payments via 835 EFT on whatever schedule you choose – annual, quarterly or monthly.

Automated Clinical Reasoning

Payer teams responsible for medical chart abstraction typically struggle to keep up with the volume of charts that must be reviewed under relentless schedule pressure. Abstractors must match each chart to each member and their care gaps and then accurately determine if all evidence required to satisfy care gap closure criteria is present.

Novillus uses HIPAA-compliant artificial intelligence combined with our years of healthcare experience to create significant efficiencies for abstractors and health plan operations by automating the process of matching charts to each member, analyzing each chart and identifying whether or not evidence satisfying gap closure criteria is present.

Learn how we helped a large health plan exceed their revenue capture targets with our solution by requesting a case study.

Contact Novillus

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