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The Future of Healthcare Runs on Connected Clinical Data

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Healthcare payers struggle with fragmented clinical data scattered across systems, leading to inefficiencies, missed revenue, and lower quality scores. It’s estimated that >50% of data contained within standard clinical sources is incomplete, non-standard, and non-interoperable.

Availity transforms this challenge into a strategic advantage by connecting and activating clinical data from all sources—turning insights into action.

Availity Clinical Solutions Meet You Where You Are — Built for Better Healthcare at Every Stage.

Built for Better Decision Making

Improve risk adjustment, close care gaps, and optimize workflows by integrating clinical data into your workflows.

Built for Better Experience

Real-time clinical data access boosts HEDIS® scores, improves care quality, and enhances member satisfaction.

Built for Better Interoperability

Automated data exchange saves millions, accelerates workflows, and delivers significant ROI compared to manual processes.

Built for Better Scale

Modular, API-driven infrastructure scales with your evolving strategy, while secure, interoperable connections ensure your organization is prepared for both current and future needs.

See how we help upcycling data to turn it into a powerful, strategic asset

Use Cases for Availity Clinical Data Solutions

Clinical Data Optimization & Integration

Transform fragmented, multi-source clinical data into standardized, actionable insights at scale.  We take in C-CDAs, FHIR, PDFs and other formats and then parse, normalize, enrich, reorganize, and deduplicate that data to make it usable across the enterprise.

Results: Processes data 17,800x faster than manual methods; with an estimated ~$370M cost avoidance for a large plan.

Operational ROI
CMS-0057 Interoperability Mandate Requirements

Meet CMS mandates with FHIR conversion, Payer-to-Payer API, Provider Access API, Patient Access APIs, and Prior Authorization APIs for seamless, compliant data exchange.

Rapid compliance can avoid $1MM+ fines and sanctions for non-compliance.

Availity P2P Cohort Solves for CMS Final Rule
Clinical Quality Improvements: HEDIS® Validation and Care Gap Identification

Automate identification and closure of care gaps in provider workflows (Essentials Portal and EHRs integrations), in real time, to boost HEDIS® and Star ratings.

Results: Achieving a 4-Star rating instead of 3.5 can mean ~$500 extra per member/year; 32% gap closure in a recent initiative.

How a Health Plan Closed Care Gaps and Increased Provider Engagement with Electronic Clinical Quality Validation
Risk Condition Validation: Closing Risk Gaps

Use advanced analytics to proactively identify and validate undocumented risk conditions, improving risk adjustment. Benefits include reduced medical spend on high and rising risk member populations via improved disease identification (e.g., CKD, CHF, DM)

Results: $18.5M added revenue from better HCC capture; significant savings in PMPY in RAF value (example: $2M – $4M+ savings for delayed progression of late-stage kidney disease for 20 to 40 members).

Care-Gap Claims Editing

Deliver care gap messages and suggested edits before claims submission, reducing rejections and improving quality capture.

Results: Automating data quality at scale can save hundreds of millions; ~$370M cost avoidance for a large plan.

Value-Based Care Analytics

Activate longitudinal clinical data for population health, risk stratification, and targeted interventions to improve outcomes and reduce costs.

Results: Timely interventions and analytics can reduce readmissions by ~18%.

https://www.availity.com/blog/data-quality-interoperability-in-value-based-care

Clinical Data Connectivity and Notifications

Enable real-time sharing of critical patient events and comprehensive clinical data across the care continuum.

  • PCP Notifications instantly alert primary care providers and care managers to hospital admissions, ER visits, and discharges, supporting timely follow-up and reducing readmissions.
  • CCD Connectivity Hub aggregates and standardizes clinical data from diverse sources, ensuring providers have a complete, actionable member record for effective care management.
  • ADT Connectivity Hub ingests hospital event feeds and delivers immediate notifications to care teams, empowering rapid intervention and improved transitions of care—all working together to drive better outcomes and seamless coordination.

Results: Timely ADT-based alerts can reduce 30-day readmissions by ~2.9–18%.

Proven Results

Availity Clinical Data Solutions

30%

Cost Reduction

Cut multi-vendor overhead and manual chart chasing with streamlined connectivity.

$460​

Member Bonus
 
Boost HEDIS® performance by delivering high-quality clinical data into workflows.

36%

Efficiency Gains
 
Automated, real-time access slashes admin processing time and chart retrieval costs.

32%

Care Gap Closure
 
Close gaps faster with fit-for-purpose clinical data integrated into provider workflows.

Availity’s Clinical Data Solutions Frequently Asked Questions

How does Availity compare to other clinical solutions?
CategoryAvailityOthers
Connectivity– Nation’s largest dual-sided real-time healthcare network
 – >95% direct health plan connectivity
 – 3.4M+ providers, 17K+ B2B partners
 – Immediate access via existing contracts and integrations		– Limited real-time connectivity and fewer direct payer relationships
 – Often require custom builds or manual onboarding
Workflow Activation– Embedded in existing provider workflows and via Essentials portal
 – Clinical + administrative data unified for holistic patient view		– Fragmented workflows across multiple platforms
 – Lack of unified clinical + administrative data
 – Often require separate systems or manual reconciliation
Network Reach– One-to-many connectivity model reduces operational lift
 – Pre-established contracts expedite value-based agreements		– Offer infrastructure but not live networks
 – Require payers to build and maintain connections
 – Slower time to value and higher IT burden
Data Accuracy– Our optimization engine applies 400+ rules to normalize and enrich clinical data
 – AI adjudication aligns with payer-specific policies for consistent decisions
 – Upcycled summaries improve care gap closure and reduce duplicate outreach		– Many rely on raw data ingestion without semantic normalization or enrichment
 – GenAI or regression models may not meet CMS or NCQA standards
 – Limited support for longitudinal views or curated summaries
 – Often require manual chart chase or lack EMR integration
Security & Trust– SOC 2 and HITRUST certified
 – HIPAA-compliant cloud infrastructure
 – Trusted intermediary across payers and providers with neutral, secure, and scalable approach		– Bloat and narrow focused (e.g., billing-only or EHR-only)
 – May lack full compliance certifications or neutrality
 – Security often varies by deployment model
What makes Availity’s data approach valuable to healthcare organizations?

Availity standardizes data from EHRs, labs, and health networks into a unified format. This gives payers and providers a complete view of patient health, enabling better decision-making, improved collaboration, and stronger outcomes.

Why is clinical data difficult to use today?

Clinical data is often unstructured and stored in different formats across systems. Claims data lives in adjudication platforms, while labs, provider notes, and test results reside in EHRs. Without normalization and context, it’s hard to match records or extract insights. Availity solves this by standardizing and enriching data for analytics and automation.

Who benefits from using a clinical data platform and clinical data connectivity?

Health plans, provider networks, health information exchanges (HIEs), and digital health companies benefit from clinical data platforms. These organizations use them to automate chart review, close care gaps, and power analytics that improve value-based care performance.

How does Availity acquire clinical data from EHRs and other systems?

Availity connects to EHRs, clearinghouses, and health systems using APIs, FHIR interfaces, and secure file exchanges. As a trusted intermediary for healthcare transactions, Availity aggregates, de-duplicates, and standardizes data so it’s ready for activation across payer workflows.

What is clinical data optimization?

Clinical data optimization transforms raw, messy inputs into structured, standardized, and coded data. It aligns information to healthcare standards like LOINC, SNOMED, and HL7, which improves accuracy and usability for analytics and AI.

What is clinical data workflow activation in healthcare?

Workflow activation means delivering enriched clinical data into platforms like care management tools, analytics dashboards, or provider portals. This allows teams to make faster decisions without manually searching for information.

How does Availity ensure data privacy and compliance?

Availity complies with HIPAA, encrypts data in transit and at rest, and enforces strict access controls. All infrastructure and processes follow healthcare industry standards for privacy, security, and interoperability.

What results do organizations typically see after implementation with Availity?

Organizations see faster quality measure validation, more accurate risk adjustment, reduced manual chart review, and improved care gap closure. These efficiencies often deliver measurable ROI within months of implementation.

What makes Availity different from other data aggregators?

Availity goes far beyond simply moving data from point A to point B like a data aggregator does. Availity offers a real-time, API-based engine that automates clinical data integration, normalization, and enrichment. This transforms raw data into actionable intelligence at scale.

Can the platform support FHIR and other interoperability standards?

Yes. Availity supports FHIR, HL7, C-CDA, and other standards, which enable seamless data exchange across EHRs, health plans, and digital health tools.

Does Availity have a solution to achieve CMS-0057-F compliance?

Yes. Availity offers a complete CMS-0057 compliance platform. It includes managed APIs, FHIR conversion, payer-to-payer connectivity, provider access, and prior authorization automation—all within a secure, scalable ecosystem.

What’s involved in onboarding and implementation?

Implementation includes system connections, data mapping, and pilot testing to validate accuracy. Availity provides dedicated onboarding support to ensure smooth integration and minimal disruption.

How can I request a demo or learn more?

You can request a demo directly from the site at the bottom of this page. The Availity team will tailor a walkthrough to your organization’s data needs, systems, and goals to help build a strong value case.