Cotiviti Helps Health Plans Act Earlier on Care Gaps and Member Needs

• New Concurrent Quality and Engagement Hub capabilities give health plans earlier visibility into quality opportunities and help coordinate action across programs

SALT LAKE CITY--(BUSINESS WIRE)--Cotiviti, The Healthcare Infrastructure Company™, today announced new capabilities that help health plans identify care gaps sooner, coordinate outreach across programs and act before opportunities are missed.

As health plans prepare for the shift to digital quality measurement led by the National Committee for Quality Assurance (NCQA), the ability to identify and act on quality opportunities earlier is becoming increasingly important. Cotiviti's new Concurrent Quality solution and expanded Engagement Hub capabilities help health plans surface opportunities earlier, reduce retrospective work and coordinate interventions across quality, risk adjustment and member engagement programs.

“Health plans don't need more data. They need a better way to turn insights into action," said Chad Kinkead, Executive Vice President of Health Enablement Solutions at Cotiviti. “By identifying priorities across programs and closing quality gaps before adjudication, we help health plans act earlier, simplify processes and improve performance across the care continuum.”

Concurrent Quality identifies missing quality-related information while claims are being processed. The solution embeds configurable alerts directly into existing billing workflows, helping organizations address gaps earlier and support more timely quality improvement efforts.

Rather than coordinating outreach and prioritizing members in silos, Engagement Hub brings opportunities across quality, risk adjustment and member engagement programs together so plans can identify members with overlapping needs, prioritize interventions by potential clinical and financial impact, coordinate outreach across teams and measure results across programs.

NCQA certified Cotiviti's Digital HEDIS^® measures for 2025, the most recent measurement year, giving health plans a trusted path toward fully digital quality reporting. As the industry moves toward more timely, clinically integrated quality measurement, plans increasingly need to identify opportunities and coordinate interventions earlier in the care journey rather than relying on retrospective chart review and supplemental data collection.

“As health plans prepare for NCQA’s transition to digital quality measurement, it’s reassuring to have a trusted partner who understands the challenges ahead and is investing in solutions to help make that transition feel more manageable," said Abby Hoffman, RN, CRC, Director of Quality at HealthTeam Advantage.

Supplemental data collection, duplicate outreach and disconnected quality efforts can create unnecessary administrative burden across the healthcare system. According to the American Hospital Association, administrative costs account for an estimated 25% to 35% of U.S. healthcare spending.

Cotiviti plans future enhancements that will continue to strengthen coordination between health plans and providers, helping organizations move from retrospective, disconnected quality activities toward a more proactive and integrated approach to improving member outcomes.

About Cotiviti

Cotiviti’s infrastructure platform enables healthcare organizations to deliver better care at lower cost through advanced technology and data analytics that improve the quality and sustainability of healthcare in the United States. Cotiviti’s solutions increase transparency and collaboration between payers and providers while empowering them to reduce medical and administrative costs, enable better health, improve claims payment efficiency, streamline operations, drive interoperability and advance value-based care. Its customers serve the majority of U.S. healthcare consumers, providing coverage and care for more than 300 million members and patients. For more information, visit www.cotiviti.com.