To effectively analyze healthcare outcomes and spending and appropriately manage clinical and financial risks, organizations need to be able to take into account the clinical complexity of each individual in a specific population. Risk adjustment is a statistical process that allows organizations to make fair comparisons of healthcare delivery and payment systems, and in so doing, identify opportunities for improvement.
Part of healthcare’s DNA for more than 25 years, DxCG Intelligence is at the core of Cotiviti’s performance analytics solutions. The gold standard in risk adjustment and predictive modeling, DxCG Intelligence analyzes and helps manage the clinical and financial risks associated with caring for populations, with specificity at the individual level.
DxCG Intelligence uses Cotiviti’s proprietary predictive models to turn healthcare data into risk scores for individual members. Scores correlate with the cost of their underlying illness burden. Aggregating the scores of individuals with key attributes generates group-level predictive results that can help answer critical questions about healthcare efficiency.
Assess the disease burden of individuals, subgroups, and populations
Predict the future cost of care for a population
Measure efficiency in healthcare resource usage
Assess performance relative to peer groups or benchmarks
Develop fair and accurate risk-based provider payment systems
Inform care management and evaluate the impact of quality programs
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:
DxCG Intelligence fully addresses cost, utilization, and risk across all populations. Our transparent, credible measures of population health risk are both clinically and financially grounded, increasing buy-in and making it easier for physicians, medical professionals, and analysts to see the impact of comorbidities, among other benefits.
DxCG Intelligence is easy to implement, whether an organization selects hosted or installed versions of the software, and integrates seamlessly with other software solutions. Our world-class customer support team supplies data acquisition and mapping support, software maintenance, educational resources, and access to our seasoned data scientists, statisticians, clinicians, and other subject-matter experts.
An unmatched legacy
A groundbreaker in the early 1990s, the DxCG models were developed in partnership with the U.S. 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.
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.
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.