Quality and Performance solutions

Answer your toughest clinical and financial improvement questions

As value-based reimbursement becomes the standard, Cotiviti’s Quality and Performance solutions allow health plans to move from simply reporting quality measures to driving the purchase, delivery, and utilization of higher value healthcare. Our solutions enable health plans to collaborate more effectively with their provider networks, with members, and with other functional teams within the plan itself. The result? Plans can successfully manage members’ clinical and financial risks, make the most of limited internal resources, and stay compliant with industry requirements and regulations.

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

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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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.

Solutions

DxCG models and their proven science form the solid foundation of an effective performance improvement program. From there, you can add solutions to gain even more value.

Medical Intelligence

Gain insights into every facet of healthcare utilization

Network Value

Obtain the solid foundation you need to shift from volume to value

Cotiviti offers a proprietary methodology for calculating what is considered to be high-value care, using the Dartmouth Atlas, Choosing Wisely, and other academic research as well as Medicare claims data (Parts A, B, and C). We then benchmark providers across their geographic and specialty peers to identify those who are most likely to succeed in risk-based arrangements. Clients can recognize and reward high-value care while eliminating low-value care, allowing them to build and optimize high-performing networks, enable provider collaboration, transition from volume to value, and drive down total cost of care.

Our comprehensive engagement model is designed to ensure that payers and providers can successfully partner in providing high-value care within existing payment models while scaling for the future. These valuable analytics form the foundation of an action plan that includes strategy development, roadmap planning, and program delivery for network optimization and development, as well as provider and member behavior change–everything you need to obtain clarity, collaboration, and results.

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