Case Study: CareOregon achieves measurable HEDIS quality improvements and Five Star ratings with Cotiviti

CareOregon - Customer Case Study

CareOregon, a Portland-based nonprofit health plan serving more than 200,000 Medicaid members and 13,000 Medicare Advantage members (many dually eligible), faced limits from a seasonal, retrospective HEDIS® process that was not driving sustained quality improvement or Five Star performance. To move from retrospective reporting to proactive, year‑round quality management, CareOregon partnered with Cotiviti and adopted Cotiviti’s Quality Intelligence software to better intake, organize, benchmark and act on HEDIS and Stars data.

Cotiviti implemented proactive HEDIS data runs, weekly gaps‑in‑care reports and custom analytics that empowered a multidisciplinary CareOregon team to target interventions, expand EMR access, and improve hybrid review processes. The approach produced measurable gains: a 22% improvement in Care for Older Adults Advance Care Planning, 13% improvement in Comprehensive Diabetes Control (HbA1c <8), a 13% reduction in poor diabetes control (HbA1c >9), and an 8.5% improvement in blood pressure control, plus Five Star ratings for Care of Older Adult measures and rheumatoid arthritis—demonstrating Cotiviti’s role in both operational efficiencies and quality score improvement.

CareOregon

Mary Naman

Health Outcomes Supervisor