How Health Plans Can Transform Clinical Data into a Strategic Asset

Health plans are facing unprecedented pressure to improve outcomes, lower costs, and operate more efficiently. Yet the clinical data needed to power these goals often remains fragmented, inconsistent, and difficult to use. Availity has developed Clinical Data Solutions to help payers overcome these challenges by making clinical data acquisition, optimization, and workflow integration more scalable, more accurate, and more actionable.

A Three-Pillar Approach to Clinical Data 

Clinical Data Acquisition

Availity helps payers establish broad, reliable connectivity across a fragmented network of providers, health information exchanges (HIEs), and clinical vendors. Our approach goes beyond single-use cases or one-off integrations. We help streamline an organization’s clinical data strategy, acquire the right data for each business objective, and extend the reach without multiplying integration costs. Whether time is spent chasing down records for risk adjustment or enabling automated prior authorizations, our scalable, use-case-driven acquisition model gets you the data you need—faster and with less friction. 

Clinical Data Optimization 

Raw clinical data is only valuable if it’s clean, complete, and easy to use. That’s where Availity’s optimization layer comes in. We parse and normalize clinical data from multiple formats, convert it into usable components, and make it ready for ingestion across an organizations’ systems. This reduces the burden on internal teams, eliminates time wasted on manual reformatting, and enables an organization’s analytics and care management teams to focus on delivering insights, not cleaning up data. 

Workflow Integration 

Most payer solutions stop at making data available. We go further by embedding clinical data directly into the administrative and clinical workflows that need it most. From supporting faster, more accurate prior authorization decisions, to improving claims processing, closing care gaps, and boosting Stars Ratings performance, Availity helps clinical data flow, adding to its value.

Built for the Real World, Ready for What’s Next 

Availity’s Clinical Data Solutions are already helping some of the nation’s largest health plans solve their most urgent data challenges. Whether an organization is focused on quality improvement, utilization management, value-based care, or risk adjustment, Availity’s platform supports multiple use cases—without adding new layers of complexity. 

We don’t just help organizations meet today’s needs, we help prepare them for what’s next in healthcare interoperability, including mandates like the Centers for Medicare & Medicaid Services Interoperability and Prior Authorization Final Rule (CMS-0057-F) and future expansions in data transparency and member access.