Health Enablement
Solutions

Strengthen health outcomes with connected
risk adjustment, quality improvement, and
engagement solutions

Download Health Enablement fact sheet

Investing in comprehensive healthcare

Better health outcomes happen when each stakeholder has a holistic understanding of the healthcare ecosystem—streamlining communications, optimizing quality benchmarks, improving compliance, and minimizing risk. Cotiviti's Health Enablement solutions empower payers to support the delivery of more impactful healthcare with a portfolio of tools that positively impact health outcomes.

With a focus on driving more informed decisions, our Risk Adjustment, Quality and Stars, and Engagement solutions enable health plans to knock down internal silos and improve efficiency. Plans can collaborate within their own teams, with their provider networks, and directly with their members to enable better care. Empower better risk adjustment and quality program performance, uncover valuable insights about member needs and behavior, help ensure appropriate resources and tailored interventions, and motivate members to act with Cotiviti’s Health Enablement solutions.

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Get a comprehensive view of member health for better outcomes

Work with a strategic partner that can provide better member care with better documentation efforts, quality measurement and reporting, and effective outreach. Efficient risk adjustment helps align proper documentation with a clear view of member health, quality efforts aid care gap identification and closure, and engagement outreach assists with health accountability across every point of contact.

The results speak for themselves:

Risk Adjustment

>$2B

average appropriate incremental risk adjustment revenue delivered to MA clients annually

>10M

charts coded annually

>97%

average coding accuracy

Quality and Stars

>147M

members reported to NCQA are processed by Quality Intelligence

>90%

HEDIS® medical record retrieval rate

>97%

medical record abstraction accuracy

Engagement

83%

of members engaged found outreaches helpful

6.7%

higher rate in breast cancer screening

3.9%

higher rate of colorectal cancer screening

3–4%

increase in comprehensive diabetes care measures

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Cotiviti's Health Enablement solutions

Gain comprehensive and cohesive solutions across risk adjustment, quality improvement, and member engagement. Click on each icon below to learn more.

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Risk Adjustment

Identify your population risk to drive better care

Enhance provider collaboration and data accuracy to better serve your members. Cotiviti’s Risk Adjustment solutions combine unique industry expertise with advanced technologies to enable health plans to identify priorities, collect timely and high-quality data across their ecosystem, and achieve accurate coding results, optimizing reimbursement for relevant care programs. Key benefits for health plans include:

  • Streamlined data acquisition, enhancing volume and quality
  • Capacity to scale and meet goals, adapting to each client evolving needs
  • Reliable results, with more than 97% average coding accuracy across all our clients

Learn more about Risk Adjustment

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Quality and Stars

Measure, analyze, and improve your clinical and financial performance with industry-leading HEDIS, Star Ratings, state reporting, and more

Move beyond simple reporting and drive the purchase, delivery, and utilization of higher-value healthcare. As value-based reimbursement becomes the standard, Cotiviti's Quality and Stars solutions enable health plans to collaborate more effectively. Implement a comprehensive, year-round measurement and reporting program that improves health plan performance and member care. As a result, plans may:

  • Successfully manage members' clinical and financial risks
  • Use limited internal resources more effectively and efficiently
  • Easily stay compliant with industry requirements and regulations

Learn more about Quality and Stars

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Engagement

Drive action and improve health activation with better member engagement

When members engage, everyone wins. But many health plans aren’t sure where to start. Cotiviti's Engagement solutions motivate members to take meaningful action. Effective outreach programs can lead to better health behaviors, increased access to healthcare services, and positive changes in health status. Gain next-level results, such as:

  • Improved clinical outcomes by closing care gaps at higher rates
  • Population insights from uncovering rising risk populations, barriers to care, network access issues, and more
  • Improved health behaviors through member education and support

Learn more about Engagement


Risk
Adjustment

Quality and
Stars
 
 

Download the Health Enablement fact sheet