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Medical Intelligence solution

Gain insights into every facet of healthcare utilization

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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.

  • Identify high-risk members in need of immediate or long-term clinical intervention
  • Pinpoint those at risk for hospitalization or emergency room (ER) use in the near future
  • Optimize the results and operational efficiency of outreach and engagement initiatives
  • Analyze population and member-level conditions, gaps in care, quality, and compliance metrics
  • Monitor and measure the progress of disease management and wellness programs and vendors
  • Identify new intervention programs needed to address conditions driving cost and utilization