To: Board of Supervisors
From: Dr. Grant Colfax, Health Services Director
Report Title: Payments for Services Provided by Cotiviti, Inc.
?Recommendation of the County Administrator ? Recommendation of Board Committee
RECOMMENDATIONS:
APPROVE and AUTHORIZE the Auditor-Controller, or designee, to pay $147,900 to Cotiviti, Inc., a corporation, for consulting and technical services provided to the Contra Costa Health Plan (CCHP) for analyzing Healthcare Effectiveness Data and Information Sets (HEDIS) for fraud, waste and abuse prevention for the months of June 1, 2025 through October 31, 2025, as recommended by the Health Services Director.
FISCAL IMPACT:
Approval of this payment will result in a one-time expenditure of up to $147,900 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 & National Committee for Quality Assurance (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 also provides the NCQA software to process the data.
Fraud, Waste, and A...
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