Case Study: Western Health Advantage achieves enhanced reporting, ACA compliance, and better patient care with Cotiviti Provider Intelligence

Western Health Advantage leverages performance analytics to improve performance, support compliance, and better serve patients

Western Health Advantage, a provider‑sponsored, not‑for‑profit HMO that has operated like an ACO for 18 years and manages more than 120,000 commercial at‑risk lives, needed to replace an overburdened in‑house reporting system to meet Covered California and ACA reporting and better manage risk‑sharing programs. To solve this, Western Health Advantage selected Cotiviti and implemented Cotiviti’s Provider Intelligence / Performance Analytics solution (including DxCG risk‑adjustment and predictive models) to normalize claims from many sources and deliver actionable, organization‑wide analytics.

Cotiviti aggregated and secured patient and claims data into a single source, added customizable reports and dashboards (including medication‑adherence and behavioral‑health flags), and enabled population segmentation with DxCG risk models. As a result, Western Health Advantage improved reporting efficiency for Covered California P4P and ACA submissions, reduced internal IT burden so staff could focus on ICD‑10 and other priorities, gained a 360° view of patient activity across sites, and identified more individuals for case management to improve care coordination and prevent adverse events.

Western Health Advantage

Don Hufford

Chief Medical Officer