DxCG Intelligence®

Identify, stratify, and manage individual
and population risk

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DxCG Intelligence is part of Cotiviti's
Risk Adjustment solution suite.

To analyze healthcare outcomes and spending effectively while managing clinical and financial risks appropriately, health plans must consider the clinical complexity of each individual within a specific population.

Discover more in risk assessment

For over 25 years, DxCG Intelligence has utilized Cotiviti's proprietary predictive models to transform healthcare data into risk scores for individual members.

The gold standard in risk assessment and predictive modeling, DxCG Intelligence helps manage the clinical and financial risks associated with caring for your member populations, delivering precise insights at the individual level.

By aggregating these individual scores with key attributes, DxCG Intelligence generates group-level predictive results to address critical questions about healthcare efficiency.

Unique insights into factors driving risk

As health plans increasingly focus on solving significant disparities in healthcare outcomes, they can depend on DxCG Intelligence to help. The latest version of our solution combines our easy-to-use health risk assessment and enhanced clinical and pharmaceutical classification systems with the identification of members at risk due to social determinants of health (SDoH) factors that may be impacting them.. Utilizing this new SDoH functionality, organized by GEOIDs, alongside our industry-standard Relative Risk Scores and SDoH Hierarchical Condition Categories, enables clients to identify high-risk members. This supports the design, deployment, and evaluation of a closed-loop strategy for improving member health.

DxCG Intelligence is the clear industry leader in risk assessment, delivering:

>28 years

years as the industry leader for risk assessment and predictive modeling

>5B

claims processed each month

20%

of U.S. population run through DxCG each month

 

DxCG Intelligence benefits and features

DxCG Intelligence fully addresses cost, utilization, and risk across all populations, empowering health plans across budgeting and underwriting, medical management, and performance assessment:

Budgeting and underwriting

  • Quantify the health risk of enrolled populations
  • Measure risk trends over time across lines of business
  • Budget for care delivery costs
  • Adjust premiums and payment rates
  • Assess reinsurance options based on risk tolerance
  • Substantiate insurance rate filing

Medical management

  • Identify high-risk individuals
  • Stratify clinical groups to define outreach strategies
  • Prioritize individuals for targeted interventions
  • Enable member outreach to improve care compliance

Performance assessment

  • Quantify physician panel risk burden
  • Establish risk-expected rate variation
  • Assess provider panel utilization variance
  • Support risk-based contracts and gain sharing
  • Promote accountability in healthcare systems
  • Analyze population health outcomes

Gain a risk assessment solution that stands out

A groundbreaker in the early 1990s, the DxCG models were developed in partnership with the Centers for Medicare & Medicaid Services (CMS) and served as the foundation for the Hierarchical Condition Category (HCC) model that CMS still uses as the foundation for risk-adjusted healthcare payments today.

DxCG Intelligence incorporates the industry's broadest set of risk management and predictive models, which in turn put the power of science to work in addressing your most pressing clinical and financial performance challenges. Models are grouped into three primary functional bundles—budgeting and underwriting, medical management, and performance assessment—as well as tailored for commercial, Medicare, and Medicaid populations, building the successful foundation for optimal results.

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