Quality Intelligence

Achieve quality compliance, and measure, report, and submit HEDIS and HEDIS-related metrics

CMS RAC

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As quality becomes increasingly tied to financial well-being, health plans are seeking better ways to optimize quality improvement programs. From ever-evolving HEDIS® measures and submission requirements, to a long and growing list of other HEDIS reporting needs, such as state-specific, pay-for-performance (P4P), Star Ratings, and custom programs—quality tracking, reporting, and compliance is complex.

90%
of surveyed plans agreed that Cotiviti’s Quality Intelligence software returns value equal to or exceeding their investment.*

 

Cotiviti’s Quality Intelligence is a measurement and reporting software that comes fully equipped with our highly flexible and comprehensive user application, Quality Reporter Web (QR Web), and NCQA-certified quality measure logic, setting the standard for efficiency, usability, and customer satisfaction.

 

With Quality Intelligence, health plans can:

  • Track, monitor, and improve quality compliance for all lines of business
  • Develop and measure proprietary quality metrics
  • Facilitate HEDIS, Medicare Advantage Stars, state-specific, and other quality measure submissions
  • Implement a year-round measurement and reporting program that significantly improves health plan rankings

 

“The seamless experience offered by Quality Reporter Web helps boost our efficiency during medical record review season." — Large nonprofit health plan

Our Quality Intelligence solution boosts some impressive results, such as:

>61%

of all members reported to NCQA in 2021 were processed by Cotiviti’s Quality Intelligence software

22

years delivering NCQA-certified measure logic

>90%

HEDIS medical record retrieval average rate and >97% abstractor accuracy rate achieved over the past three HEDIS seasons

Quality Intelligence solution benefits and features

With Cotiviti’s Quality Intelligence, health plans get a tracking system for keeping an eye on quality compliance and metrics that includes the following benefits:

  • Transparent data model. With visibility and insight at every level—from the initial claim to intermediate tables for measure processing to the final results—you know exactly where to find your best improvement opportunities.
  • A single resource to analyze and report HEDIS-related metrics. Quality Intelligence helps you keep a vigilant eye on complex and rapidly evolving healthcare quality metrics with its highly flexible and comprehensive user application, Quality Reporter Web. All aspects of your HEDIS project are included in this single application including HEDIS reporting, measure analysis, retrieval and abstraction workflows and submission tools.
  • Design a program that best meets your needs. Cotiviti has a well-deserved reputation for flexibility. Choose from either a full-service model, supported by a Cotiviti data operations specialist, or a self-service model, setting your own processing schedule and data runs.
  • Pick your measures. In addition to the standard HEDIS measures, Cotiviti has a robust library of quality measures customers can choose from including CMS Core Medicaid measures, Star Ratings Part D measures, as well as state Medicaid, and custom measures.
  • Integrate with other solutions for a holistic view. Add Star Intelligence or Eliza® to utilize a single source of quality data. Star Intelligence helps track, predict, and support the path to improve member care and Star Ratings, and to maximize quality bonus payments. Plans can also support member engagement programs and close quality care gaps by seamlessly sending member data to Eliza.
  • Reduce abrasion and gain transparency. Streamlined HEDIS Medical Record Retrieval and real-time compliance Medical Record Abstraction services may be added to help fulfill high-volume record requests with minimal disruption to providers and their staff and achieve the highest number of compliant components possible within any reporting timeframe.

*Source: TechValidate. TVID: 4A3-012-53E

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

Gain a quality improvement solution a cut above the rest

Our Quality Intelligence solution has many features that differentiate it from the competition, such as:

  • A best-in-class turnkey solution. Get a simplified HEDIS experience focused on quality improvement—not program administration.
  • Clinical insight. Get a 360° point of view—our team of clinical consultants provides direction and insight to the intricate details of claims and data processing.
  • NCQA collaboration. Benefit from NCQA collaboration. We work closely with NCQA to deliver the highest quality measures and to represent the voices and concerns of our clients to NCQA.
  • Auditor summit. Cotiviti hosts an annual auditor summit providing client auditing firms with insights and understanding of our tools, people, and processes to better assist clients in both ongoing and annual audit matters.
  • Integration. No need to revamp existing systems—certified HEDIS measure scores can be integrated with our performance analytics suite, supporting both population health and provider reporting initiatives. HEDIS Medical Record Retrieval & Abstraction is fully integrated into Cotiviti’s Quality Intelligence solution, allowing for thorough documentation of compliant care, reduced provider abrasion, and quality score improvement.

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