To: Board of Supervisors
From: Dr. Grant Colfax, Health Services Director
Report Title: Contract #27-791-14 with Cotiviti, Inc.
?Recommendation of the County Administrator ? Recommendation of Board Committee
RECOMMENDATIONS:
APPROVE and AUTHORIZE the Health Services Director, or designee, to execute on behalf of the County Contract #27-791-14 with Cotiviti, Inc., a corporation, in an amount not to exceed $3,000,000 to provide a hosted software solution for analyzing Healthcare Effectiveness Data and Information Sets (HEDIS) for fraud, waste and abuse for Contra Costa Health Plan (CCHP) for the period November 1, 2025 through October 31, 2028.
FISCAL IMPACT:
This Contract will result in contractual service expenditures of up to $3,000,000 over a 3-year period and will be funded 100% by CCHP Enterprise Fund II revenues.
BACKGROUND:
This Contract meets the needs of the County's population by providing data analysis software for HEDIS projects and reports to support State and contractual requirements for CCHP. Cotiviti, Inc. provides its licensed program, Quality Intelligence, used by CCHP to calculate and analyze HEDIS measures. CCHP began contracting for these services with this vendor in November 2009. HEDIS Measures & NCQA Accreditation certification is a requirement of the Department of Health Care Services (DHCS), for which CCHP is assessed. HEDIS is required for NCQA Accreditation and DHCS compliance. HEDIS scores are used to determine Plan assignment, and therefore impact capitation payments from the state. HEDIS will further be used for Quality Rate Factor payments in which capitation is not only based on monthly membership numbers but also HEDIS scores in comparison to other Plans. HEDIS is a heavily structured, highly audited process and calculations will not be accepted without the use of NCQA certified software to process the data. Under this Contract, Cotiviti provides the NCQA software to process the data.
CCHP is contractually and legally requi...
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