Although the U.S. healthcare system continues to face the turmoil of competing priorities and approaches, the desire to control escalating costs through greater efficiency remains constant. The key to efficiency is effective risk identification, stratification, and management.
To succeed in managing population-based clinical and financial risk, payer organizations need answers to highly complex questions about healthcare costs, quality, and utilization. Use of advanced data analytics leads to the efficient, accurate discovery of critical business performance insights.
Medical Intelligence combines Cotiviti’s industry-leading DxCG science, evidence-based clinical quality rules, healthcare utilization metrics, and claims-based HEDIS measures to enable payers to manage risk and target opportunities for improving healthcare results. Users can easily stratify and segment populations (by risk, costs, utilization, predicted future cost, or location), access member-level detail (e.g., conditions, comorbidities, clinical events, gaps in care, prescription compliance), and evaluate efficiency and performance by program, provider, and more.
For population health management, Medical Intelligence helps:
For clinical program design and evaluation, Medical Intelligence helps:
For network management, Medical Intelligence helps:
For medical cost management, Medical Intelligence helps:
Medical Intelligence helps payers, providers, employers/brokers, third-party administrators, and others meet several critical goals:
Cotiviti makes creating your own dashboards simple with Vital Instant Insight Widgets (VIIWs), preconfigured charts that answer commonly asked questions about healthcare cost, quality, and utilization. We also help clients jump-start their analytics with standard dashboards (e.g., Emergency Department Visit).
In addition to a broad range of powerful pre-built analytics, Medical Intelligence users can query their data in a variety of ways:
Users have access to both standard and customized reports, as well as the ability to autogenerate and distribute these reports on a specified schedule.
Organizations looking for enhanced visualization and reporting capabilities can add Enterprise Intelligence, a component of Medical Intelligence that enables power users to dive deep into data discovery and visualization, leveraging online analytical processing (OLAP) technology.
At the heart of Medical Intelligence is DxCG Intelligence, the gold standard in risk adjustment and predictive modeling. Part of healthcare’s DNA for 20 years, DxCG Intelligence uses Cotiviti’s proprietary predictive models to turn healthcare data into risk scores for individual patients and identify the primary drivers of 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.