Analyze, communicate, and improve your clinical and financial performance
As value-based reimbursement becomes the standard,
Quality IntelligenceMeasure and report HEDIS and HEDIS-related metrics your way
Star NavigatorBenefit 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.
Medical Record RetrievalFulfill 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.
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.
Medical IntelligenceGain insights into every facet of healthcare utilization
DxCG IntelligenceClearly understand and predict individual and population risk
Part of healthcare’s DNA for 20 years, DxCG Intelligence is the gold standard in risk adjustment and predictive modeling. DxCG Intelligence uses Cotiviti’s proprietary predictive models to turn healthcare data into risk scores for individual patients and identify primary drivers of the risk. Scores correlate with the cost of the underlying illness burden that individuals carry. Aggregating the scores of individuals with key attributes generates group-level predictive results that can be applied to answer questions fundamental to the ability to manage clinical and financial risks.
Nearly 500 organizations use DxCG Intelligence, which provides a common language of risk adjustment for healthcare payers and providers, for employers, for government agencies, and for academic researchers investigating ways to improve healthcare administration and delivery.
Cotiviti has been honored to advance the science of risk scoring by working with the Society of Actuaries (SOA) over the past two decades. SOA’s rigor and effort to resolve potential disparities in the analysis ensure a comprehensive evaluation of commercial risk adjustment and predictive models.
SOA’s latest study was published in 2016. Similar to their previous evaluation in 2007, DxCG models were top performers across the study.
DxCG is the clear industry leader in:
Network ValueObtain 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, and provider and member behavior change – everything you need to obtain clarity, collaboration, and results.
