Cotiviti’s preeminent risk assessment and predictive modeling tool continues to aid in improving healthcare cost and quality

SALT LAKE CITY, JANUARY 25, 2022 – Cotiviti is celebrating the 25th anniversary of DxCG Intelligence, the healthcare industry standard in risk assessment and predictive modeling, by introducing major enhancements to enable healthcare organizations to more accurately measure risk and improve care for their populations. Containing enhanced clinical and pharmaceutical classification systems including an expanded set of Hierarchical Condition Categories (HCCs), DxCG Intelligence v6.0 expands social determinants of health (SDoH) classifications to identify health plan members experiencing socioeconomic and psychosocial difficulties such as homelessness, poverty, and abuse. The latest release also features newly recalibrated models based on the latest benchmark data for commercial, Medicare, and Medicaid populations.

“This milestone demonstrates the strength and continued leadership of DxCG Intelligence across the healthcare industry, particularly for payers and providers,” said Emad Rizk, M.D., chairman, president, and CEO of Cotiviti. “As the pandemic continues to illuminate disparities in our healthcare system, expanding access to data around social determinants of health in our models will aid in reducing bias and enable more accurate assessments of member risk. In this era of increased transparency and value-based programs, both payer and provider organizations require accurate and explainable risk scores, and our newly improved DxCG models meet this challenge.”

DxCG Intelligence analyzes and helps manage the clinical and financial risks associated with caring for healthcare populations, with specificity at the individual level. By expanding SDoH classifications based on an claims data, organizations using DxCG models are now able to better account for SDoH disparities in a population. This may increase risk score and coding accuracy, influencing payment based on risk adjustment, provider comparison, and medical management.

“With ongoing changes in the healthcare industry including new diagnoses, drug codes, practice patterns and shifting costs, this update to DxCG Intelligence helps ensure that our models will continue to meet and exceed healthcare organizations’ needs,” said RaeAnn Grossman, executive vice president of population health management, risk adjustment, and quality operations at Cotiviti. “Cotiviti researchers continually analyze and innovate around the healthcare landscape, evaluating the impact on DxCG models and the risk and clinical scores produced. Recalibrating models generates predictions based on the most recent and relevant data, allowing healthcare organizations to make sound business decisions with the highest degree of accuracy.”

DxCG models were originally developed in partnership with the U.S. Centers for Medicare & Medicaid Services (CMS) and served as the foundation for the HCC model that CMS still uses as the basis for risk-adjusted healthcare payments today. Recognized by research published by the Society of Actuaries for strong performance, DxCG Intelligence uses Cotiviti’s proprietary predictive models to turn healthcare data into risk scores for individuals, which correlate with the cost of that individual’s illness burden. This data can then be aggregated to help manage the clinical and financial risks associated with caring for populations. Today, more than 100 healthcare payers, providers, employers, government agencies, consultants, brokers, and academic researchers across the country use DxCG Intelligence to support risk assessment.

About Cotiviti
Cotiviti is a leading solutions and analytics company that is reshaping the economics of healthcare, helping its clients uncover new opportunities to unlock value. Cotiviti’s solutions are a critical foundation for healthcare payers in their mission to lower healthcare costs and improve quality through higher performing payment accuracy, quality improvement, risk adjustment, consumer engagement, and network performance management programs. Cotiviti’s healthcare solutions are powered by Caspian Clarity, a proprietary data and analytics platform spanning thousands of unique member and provider data types across financial and clinical domains, representing the most comprehensive longitudinal data set in healthcare. The company also supports the retail industry with data management and recovery audit services that improve business outcomes. For more information, visit www.cotiviti.com.

Media Contact
Kara McCrudden
Aria Marketing for Cotiviti
kmccrudden@ariamarketing.com
(401) 474-3308