Quality and Performance

Cotiviti quality measurement, reporting, and improvement solutions

Take your quality improvement program to the next level

Quality improvement is complex, evolving, and increasingly tied to financial profitability. Cotiviti can help you turn quality measurement and reporting into the rock-solid foundation you need to support such mission-critical initiatives as population health, quality improvement, compliance, network management and contracting, and value-based reimbursement. We blend our NCQA-certified measure logic and easy-to-use reporting software with high-volume, expert retrieval and abstraction services for overall process excellence, driving the best results with the least amount of your effort at every stage.

Powerful, award-winning software

With a unified view across measures, Quality Intelligence drives a level of efficiency that enables proactive year-round measurement and reporting, allowing health plans to continuously refine their quality improvement programs and achieve better results.

Quality Intelligence won the 2017 Best in KLAS award for payer quality analytics and reporting solutions. KLAS Research used its well-established methodologies and exhaustive customer research to evaluate vendor and solution performance across multiple categories. Customers noted, in particular, that Cotiviti leads the competition in terms of software performance and ease of use.

Accurate, resource-efficient services

The thorough documentation of compliant care leads to improved quality scores. Cotiviti has extensive, proven experience performing medical record retrieval and abstraction services for a wide range of purposes. The volumes that we process have provided us with vast historical provider-related details (stored in our unique master record locator) about how best to obtain records without disrupting the physician office. In addition, our abstractors undergo rigorous training to achieve the highest number of compliant components possible within any reporting timeframe.

Customer support excellence

Quality measurement and reporting is tough, and the last thing you need is a vendor that makes it tougher. Cotiviti has a well-known reputation for flexibility and dedication to client satisfaction. We take your trust in us as a partner seriously and provide thoroughly trained and experienced resources; timely responses and product updates; and accurate, rapid, secure data management processes at all times.

Solutions

The Quality Intelligence software forms the solid foundation of an effective quality improvement program. From there, you can add solutions to gain even more value.

Quality Intelligence

Measure and report HEDIS and HEDIS-related metrics your way

Quality Intelligence, our fully NCQA-certified quality measure logic and reporting software, sets the standard for efficiency, ease-of-use, and customer satisfaction. Health plans can track, monitor, and improve quality compliance; develop and measure proprietary quality metrics; facilitate HEDIS, Star Ratings, and other quality measure submissions; and implement a year-round measurement and reporting program that significantly improves health plan rankings. Maybe that’s why 68 percent of health plan members for whom HEDIS scores are reported run through our software.

Clients can choose from two deployment options:

Full service, in which designated Cotiviti data operations personnel support your runs throughout the year
Self service, where you have the flexibility to set your own processing schedule and number of data runs and otherwise own the entire process

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>200 quality measures—and growing

Quality Intelligence is a powerful resource that you can use to keep a vigilant eye on complex, wide-ranging, and evolving healthcare quality metrics. Supported measure sets include:

AHCA Measures (Florida Medicaid)
California P4P Measures
California Medi-Cal Medicaid Measures
CMS Adult Core Set
CMS Children Core Set
CMS Stars Part D Measures
Covered California Measures
District of Columbia Measures
Georgia Medicaid Measures
Hawaii Medicaid Quest Integration Measures
HEDIS Measures

Illinois ICP Medicaid Measures
Kentucky Medicaid Measures
Louisiana Medicaid Measures
Maryland Measures
New Jersey Measures
New York QARR Measures
Pennsylvania Medicaid CHIP Measures
PQA Measures
Virginia MMP Measures
Wisconsin HMO P4P Measures
Custom Measures

Star Navigator

Benefit from a deeper level of support to optimize Star Ratings

Star Navigator is a quality improvement solution that helps Medicare Advantage plans determine the most direct path to higher Star Ratings, then track and communicate their progress toward goals. With Star Navigator, health plans gain the insights necessary to efficiently close care gaps, enlisting providers as partners in quality improvement while providing a better member experience. Star Navigator eases the process of tracking annual changes to the program from the Centers for Medicare & Medicaid Services (CMS) and requires minimal IT support, providing a turnkey solution for Star Ratings optimization.

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Medical Record Retrieval

Fulfill even high-volume record requests with minimal disruption to providers and their office staff

Cotiviti’s Medical Record Retrieval services streamline medical record retrieval, aggregation, indexing, and storage. With Cotiviti, plans can easily achieve or exceed their retrieval targets because we use provider weighting algorithms to avoid unnecessary effort, eliminate medical record image transfer downtime, and offer full transparency into retrieval status at request, project, and provider levels. This is why we’ve exceeded the market standard in medical record retrieval for the past two years, and have achieved a greater than 90 percent retrieval rate on average over the last three.

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Medical Record Abstraction

Achieve the highest number of compliant components possible within any reporting timeframe

Cotiviti experts abstract medical record information to validate that recommended care has been provided, supporting health plan quality measurement submissions.

Two qualities set Cotiviti apart in the delivery of abstraction services and account for our greater than 97 percent accuracy rates since 2015. First, focus, rigorous training, and continuous quality assurance ensure consistent performance, and our experts are just a phone call away for any questions. Second, we are incredibly flexible: We can support client-specific data formats including abstraction and over-read, MRRV only, direct EMR abstraction, and off-season projects—and we can easily scale to meet your needs, no matter the volume.

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Cotiviti performance analytics solutions

Tame your data and optimize your clinical and financial performance with one partner

Payers and every other healthcare stakeholder need answers to highly complex questions about healthcare costs, quality, utilization, and value. Use of advanced data analytics leads to the efficient, accurate discovery of critical business performance insights.

Cotiviti’s performance analytics solutions simplify the aggregation and organization of healthcare data to uncover member-, population-, and provider-level opportunities to mitigate clinical and financial risk.

Deep and broad analytic capabilities

Our solutions help payers, providers, self-insured employers, insurance brokers, third-party administrators, government agencies, and anyone else interested in a deep understanding of healthcare risk and utilization.

Population risk identification and stratification: organize and prioritize any population with speed, accuracy, and superior predictive power using DxCG Intelligence, the industry’s gold standard in risk adjustment and predictive modeling for decades
Performance trending: find opportunities in the complex interplay of healthcare cost, quality, and utilization data
Individual-level clinical insights: get the drilldown insights into each healthcare consumer that drive the most effective interventions
Provider performance assessment and network management: identify key trends at the provider level that drive more effective collaboration with your provider network in quality improvement, network management, and the pursuit of value-based care
Ad hoc data integration and reporting: take a deep dive into data discovery and visualization to deliver enhanced reporting

Data management excellence

Our track record of success in managing very large claim sets and other clinical data—we process more than 75 billion claims files per year for an extensive array of purposes—allows risk-bearing entities to create a true longitudinal record across many settings of care and gain insights to fuel both current and future-state strategies.

Industry-leading analytics

DxCG risk adjustment and predictive models were developed in partnership with CMS and served as the foundation for its Hierarchical Condition Category (HCC) models. DxCG has proven its continued, expanded utility in evolving payment programs (e.g., Medicare Advantage, Health Insurance Marketplace).

DxCG has an extensive worldwide customer base that includes nearly 500 organizations. It is the preferred choice of the nation’s leading health plans, third-party administrators, providers, accountable care organizations, state Medicaid agencies, Health Insurance Exchanges, self-insured employers, and benefit brokers/consultants, and it is used extensively by leading academic institutions to inform research.

New to the Cotiviti family are RowdMap Risk-Readiness^® Benchmarks, which help health plans, providers, and hospital systems identify and reduce low-value care from inefficient and unnecessary services. Used by top health plans as the basis for pay-for-value and other quality improvement initiatives, these benchmarks comprehensively describe the value and risk inherent in practice patterns and referral relationships of nearly every physician and hospital in the United States.

A partner you can trust

For decades, Cotiviti has been singularly focused on data management and analytics, which allows us to truly lay claim to broad and deep risk management expertise. We listen and learn, which has earned us the reputation for creating long, collaborative, and productive partnerships with our clients in which their success is always our top priority.