Cotiviti - Actuarial Clinical Decision Support (ACDS)
Project: Actuarial Clinical Decision Support (ACDS)
The ACDS exploratory research project is charted to explore and validate methods to inform the economic dimensions of clinical decisions to reduce adverse clinical and financial outcomes. Providers consider economic factors when making many clinical decisions, including potential for prior-authorization, coverage, reimbursement, overutilization, misdiagnosis, malpractice, patient deductible and responsibility, fraud waste and abuse, among others. Many systems provide clinical decision support; however, the financial, actuarial, and economic dimensions often lack explicit support.
Business and healthcare participants in this project will research actuarial models that could be integrated into EHR systems to bring transparency into the financial aspects of clinical decisions and provide explicit guidance to optimize the long-term effectiveness and efficiency of care. Technical participants will research and develop experimental machine learning models and EHR system integration architecture. Business and technical participants will research and develop prototype user interfaces and user experience workflows. Participants will have access to real-world clinical and financial data as well as Cotiviti’s quality measures and performance models. Inputs might include information about the financial risks of prior-authorization or claim denial. Inputs might also include information about the long-term financial and clinical risks of delayed or missed care, such as screenings, diagnosis, and interventions. The project objectives include delivery of a findings report and presentation and a technical demo of any prototype software capabilities.
Company Description: Cotiviti is a leading healthcare informatics company that optimizes the economics of health care with integrated clinical and financial solutions. Cotiviti serves as a trusted intermediary to align and facilitate payer, provider, and purchaser cooperation toward a common interest in the health and wellness of patients. With business units in payment accuracy, risk adjustment, performance analytics, quality improvement, and consumer engagement, Cotiviti insights uncover hidden opportunities for healthcare organizations to collaborate and cooperate in ways that drive toward The Quadruple Aim of Health Care.
NOTE: This is a virtual experiential learning opportunity. Preference is given to students in the UOnline MS in Nursing Informatics program. Contact your department directly if you would like this experience to count towards capstone requirements.