Best of 2024: Explore Cotiviti’s top content from last year

As 2025 begins, payers are navigating critical opportunities to innovate and excel in healthcare operations. From enhancing interoperability to tackling rising medical loss ratios (MLR) and leveraging artificial intelligence (AI), there’s no shortage of challenges and transformative possibilities on the horizon.

Set your plan up for success with insights from Cotiviti’s top trending content of 2024. Discover how to improve quality outcomes, reduce costs, and embrace cutting-edge technologies with these key resources.

Embracing interoperability and digital quality

Interoperability has become a cornerstone for improving risk adjustment and quality programs, enabling secure, seamless data exchange across healthcare systems.

• Explore actionable strategies in our white paper, How payers can execute high-performing interoperability programs to enable clinical data by Katie Devlin , DHSc, MS, CPHIMS, vice president of interoperability, which dives into overcoming barriers like legacy infrastructure, vendor alignment, and stakeholder collaboration .
• Stay ahead of the curve with our RISE Radio podcast episode, Staying ahead of interoperability to drive lasting impact, as we discuss the latest developments shaping the future of data exchange.

Tackling rising MLR and drug costs

With increasing utilization and declining reimbursement rates, payers are under pressure to tackle rising MLR while maintaining quality care.

• Want to learn key strategies to curb rising MLR in 2025 while protecting the integrity of claim payments? Industry expert Michael Jablon, vice president of product management, shares three essential strategies every payer should know in our in-depth blog post, 3 strategies for payers to curb increasing medical loss ratios.
• Tackle the rising costs of specialty drugs, a major driver of MLR, with insights from our white paper, Specialty drugs: Ensuring payment accuracy beyond prior authorizations, by Jonathan Starr, PharmD, director of content solutions, and Matthew Herbein, vice president of audit operations. This resource explores common challenges like billing issues, coding errors, and fraud, while offering practical solutions to improve payment accuracy.

Building AI into healthcare operations

AI is reshaping how payers manage operations, offering new opportunities to enhance payment integrity and efficiency while preserving human expertise.

• Discover practical applications of AI in healthcare with our eBook, The evolving role of artificial intelligence in payment integrity written by Brett Arnold, senior vice president of product management, and Anandhi Periyanan, senior vice president of R&D. Learn how AI can improve accuracy, streamline operations, and mitigate risks.
• See AI in action: Read our case study, Health plan finds new value with AI-enabled clinical reviews, to learn how a large regional health plan leveraged AI-driven chart selection to transform its clinical review program. The result? A sixfold increase in payment errors captured within just one year.