Quality & Risk
Quality & Risk
Proactively close care gaps and boost HEDIS, Star, and RAF scores with real-time clinical insights
The Challenge
Managing quality and risk across your membership is complex:
- Delayed data: Claims often arrive weeks after a service, and lab/ADT feeds can sit siloed
- Missed opportunities: Small care gaps grow into costly complications before you even know they exist
- High integration costs: Stitching together EHR, lab and HIE streams is time-consuming and expensive
The Opala Solution
Opala HealthSynq™ brings every relevant data source into a single, normalized stream—so you can act while it still matters:
- 97% of patient matching accuracy
- Out-of-the-box ingestion of FHIR, CCD, labs, ADTs and Da Vinci CDex messages
- Clean, analytics-ready data delivered directly to your BI tools or via API
- Rapid deployment: Go from contract to production in 4-6 weeks
With this unified view, you can:
- Identify and close HEDIS and Star care gaps ahead of deadlines
- Identify and capture high-cost HCC risk codes
- Monitor quality measures and risk in near real time
- Target high-risk members to reduce avoidable admissions
How It Works
- Build your roster
We use our state-of-the-art matching engine to link your claims to EHR identities – achieving up to 97% match rates - Enrich with clinical feeds
Providers receive those rosters to send back labs, ADTs, and FHIR payloads for your exact member set - Normalize & deliver
We correlate everything with your claims, normalize the data, and push it into your analytics stack
Customer Spotlight
“By implementing Opala’s CDex integration with the largest health system in the Pacific Northwest, we improved our quality and risk scores by capturing 40% more EHR data – atop being the first in the nation to deploy the full Da Vinci CDex guide.”
– Leading Blue Plan