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Provider Intelligence (PI) Tool

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Highmark has partnered with Cotiviti, Inc. to provide access to the Provider Intelligence (PI) Tool, which is an application that can be used to understand risk, cost, and performance across a provider's True Performance patient panel.

The application facilities risk identification and risk stratification, as well as pinpointing opportunities for clinically sound, financially effective interventions. The PI Tool enables you to reduce inefficient use of resources, optimize clinical value, improve the patient experience, and measure variation in quality and performance.

 

The PI Tool includes your panel of True Performance attributed patients. In the application you can:

  • Design and measure the impact of care management and wellness programs 
  • Identify, implement, and evaluate actionable patient-level clinical interventions
  • Improve the operational efficiency and clinical outcomes of patient outreach and engagement
  • Drive accountable care strategies and inform other alternative quality contract initiatives
  • Measure and improve year-round compliance with quality-of-care guidelines

 

Data can be viewed in the aggregate as well as at the patient-level. Data elements available include:

  • Eligibility and Patient Demographics
  • Medical Claims Information
  • Pharmacy Claims Information
  • Risk Scores and Drivers of Risk
  • Lab Results
  • Health Risk Assessment Responses

PI Tool Newsletter 

Highmark creates a bi-annual newsletter for external PI Tool users to assist them in their efforts to improve health outcomes and reduce total cost of care. You can view the PI Tool Newsletter HERE.

Cotiviti Recorded Training Webinars

Session #1 - Provider Intelligence Training: Navigating Executive Dashboard

Session #2 - Provider Intelligence Training: ER Analysis Using ER Standard Dashboard

Session #3 - Provider Intelligence Training: ER Analysis with Focus on Likelihood Scores

Session #4 - Provider Intelligence Training: Inpatient Analytics with Focus on ACSC Admissions

Instructional Videos

To learn more about the PI Tool and how to perform specific functions within the tool, please view the videos below.

Video #1 - How to Look Up an Individual Patient

Video #2 - Batch Report Creator Functionality

Video #3 - Where to Find Avoidable Emergency Room Visit Data

Last updated on 12/2/2022 9:18:10 AM

 

To access the PI Tool, log into NaviNet and click on Quality Blue from the left-hand menu. From the Quality Blue homepage, click on the option for Reports, and then the link for the PI Tool. If you do not have access to the Quality Blue page in NaviNet, please contact the Security Officer for your organization, or contact your Highmark Client Engagement Coordinator or Provider Account Liaison.
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Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration.