Cotiviti Quality Intelligence is a comprehensive measurement and reporting solution designed for health plans to manage and improve quality compliance and performance. It was named the 2024 Best in KLAS for Payer Quality Measurement and Reporting, validating its market leadership and customer satisfaction. The solution is built on NCQA-certified quality measure logic, which Cotiviti has maintained for over two decades, ensuring accuracy and reliability for critical regulatory submissions.
Key Features and Capabilities
The core of the platform is the Quality Reporter Web application, a highly flexible and comprehensive user interface that streamlines quality improvement workflows. The platform provides a transparent data model, offering visibility from the initial claim to final results, which helps identify opportunities for improvement. It supports a year-round measurement and reporting program, moving beyond just the annual HEDIS season.
Key capabilities include:
- HEDIS Reporting and Submission: A single resource for analyzing, reporting, and creating HEDIS submission files simply and efficiently.
- Quality Reporter Web: A web-based application offering enhanced workflows, centralized reporting, and real-time compliance insights.
- NCQA-Certified Logic: Utilizes fully NCQA-certified quality measure logic for HEDIS, Star Ratings, and other quality measure submissions.
- Proprietary Metric Development: Allows health plans to develop and measure their own proprietary quality metrics.
- Integrated Services: Seamlessly integrates with Cotiviti's Medical Record Retrieval and Abstraction services to optimize data collection and accuracy (e.g., >90% average HEDIS medical record retrieval rate).
- Provider Reporting: New provider reporting capabilities enable analysis of provider performance against HEDIS measures and Star Ratings cut points, facilitating configurable provider scorecards.
- Executive Dashboard: Provides at-a-glance KPIs for overall program operations and progress toward strategic initiatives.
Target Users and Use Cases
Target Users: Health plan professionals including Quality Improvement Directors, Reporting Analysts, Abstraction Managers, Retrieval Agents, and Abstractors.
Primary Use Cases:
- Regulatory Compliance: Facilitating accurate and timely submission of HEDIS®, Medicare Advantage Stars, and state-specific quality measures.
- Quality Improvement: Implementing a year-round program to track, monitor, and improve quality compliance and health plan rankings.
- Care Gap Closure: Identifying and closing member-level care gaps through drill-down claim detail and integration with engagement solutions like Eliza®/Engagement Hub.
- Performance Analytics: Analyzing provider and provider group performance against quality metrics to inform pay-for-performance and alternative quality contracts.