Quality and Performance solutions

Analyze, communicate, and improve your clinical and financial performance with industry-leading HEDIS® reporting and more

CMS RAC

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.

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From the Cotiviti blog

HEDIS STRATEGIES: 4 WAYS TO PREPARE FOR THE ECDS TRANSITION

The HEDIS ECDS reporting standard provides payers with a method to collect and then report structured electronic clinical data for HEDIS quality measures, but health plans have struggled with implementation. Here are four strategies for payers to adopt to optimize their HEDIS scores and efficiency.

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Cotiviti's Quality and Performance solutions enable transformative quality measurement and reporting, population health management, network management, and underwriting initiatives with a "single source of truth"—and a collaborative approach to analysis and action. Our Quality and Stars solutions enable payers to meet evolving requirements for HEDIS®, Star Ratings, state measures, and more. Our Network and Clinical Analytics solutions simplify the aggregation and organization of healthcare data to uncover member-, population-, and provider-level opportunities to mitigate clinical and financial risk. Integration between our quality improvement solutions and the Eliza® member engagement platform offers a clear path from identifying care gaps to closing them.



Greater breadth and depth

61%

of all members reported to NCQA in 2021 were processed by Quality Intelligence

Delivering better results

>90%

medical record retrieval rate since 2017

A commitment to quality

>97%

abstraction accuracy since 2015

Take your HEDIS and Star Ratings results to the next level

 

Qaulity Improvement Solutions

 

quality intelligenceQuality Intelligence

Measure and report HEDIS and quality-related metrics your way

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star intelligenceStar Intelligence

Optimize Medicare Advantage Star Ratings

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medical record retrievalMedical Record Retrieval

Achieve >90% medical record retrieval success with a streamlined solution

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medical record abstractionMedical Record Abstraction

Achieve >97% abstraction accuracy without hiring and training new staff

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

 

Qaulity Improvement Solutions

 

medical intelligenceMedical Intelligence

Gain insights into every facet of healthcare utilization

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DxCG intelligenceDxCG Intelligence

Clearly understand and predict individual and population risk

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network intelligenceNetwork Intelligence

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

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

Download the Quality and Performance brochure