Case Study: Children’s Community Health Plan achieves better care coordination and improved quality measures (16% asthma controller fill increase) with Cotiviti (formerly Verscend)

How performance analytics and quality reporting helped drive coordinated care

Children's Community Health Plan faced major disruption after Medicaid expansion—membership jumped from about 45,000 to 137,000 and many new enrollees had limited prior data, making it hard to manage care, set benchmarks, and support pay-for-performance (P4P) incentives. To address this, CCHP turned to Cotiviti and its performance analytics offerings (Medical Intelligence, Provider Intelligence, and HEDIS reporting) for better data, benchmarking, and provider engagement.

Cotiviti’s solutions enabled care coordinators and providers to share up-to-date patient data, identify gaps, and target interventions; care managers became more proactive and clinics were able to align incentives through P4P programs. As a result, CCHP improved quality reporting and targeted outreach (for example, identifying noncompliant diabetic members), and achieved measurable impact including a 16% increase in controller fills among a segment of asthmatic members.

Children's Community Health Plan