Medicare Advantage Stars Rating Optimization

Looming changes in Medicare star ratings will amplify challenges and costs for payers that aren’t prepared. We’ve got you covered.

The costs associated with a drop in Medicare star rating are steep: A one-point drop can mean losses of up to $1 billion. With Medicare star ratings set to change again in 2027, payers must prepare now for new requirements and reduced bonuses. But a combination of insufficient data and manual processes keeps many organizations in reactive mode—creating an increasingly costly cycle.

What if you could break out of that reactive cycle—with data acting as a partner in driving health equity?

That’s where we come in. Combining payer experience with deep data and technical capabilities, we’ll prepare you to succeed under the evolving Medicare stars system by optimizing your programs—using data and best-in-class cost practices. We understand the key levers for influencing the Medicare stars rating as well as the limited window for impact. We also recognize the central role of data in this equation. That’s why we emphasize efforts that can accelerate your move toward an optimal program and data environment.

Our Medicare Advantage and Part D Rating Optimization offering is designed to get you on the path to improvement quickly. You’ll have insight about where and how to improve in just weeks—prior to making significant investments.

Results You Can Expect

Reduce costs and administrative burden: An average payer with two million members wastes about $2.5 million in manual data processes
Grow your membership faster: Payers can lose up to 12% enrollment because of a one-star rating decrease
Lower the cost of care
Enable better patient outcomes

What We Offer

Target the right investments to improve your Medicare star rating

Do you have the right strategy to optimize your Medicare star rating? Are you implementing it efficiently? We’ll help you answer those questions. Our benchmarking and rating forecast pinpoints practical areas for program improvement. With this insight, we can recommend high-impact investments that can generate maximum return for your Medicare star rating—with an eye toward mitigating administrative waste in the near term while taking advantage of emerging technology to automate manual processes moving forward.

Optimize your data to drive performance and ratings

Are you making optimal use of data to drive your Medicare star rating? Many payers currently don’t—and can’t—due to technology and other limitations. Our data assessment looks at your technology landscape and architecture; data availability, usability, and processes; and current reporting and insights. We identify data gaps and highlight recommendations for using data to automate manual processes and alleviate administrative burdens tailored to your specific priorities and resources. We’ll also help you design an optimal data landscape for managing your star rating—one that’s accessible, scalable, and adaptable for future changes.

Move from roadmap to real results—swiftly and efficiently

Are you prepared to execute quickly on improvement opportunities? Our Medicare Star Rating Optimization offering produces fast recommendations—but we don’t just hand over a plan. We’ll be right alongside your team, providing the necessary expertise for delivering your program and data improvement roadmaps—including industry, change management, process optimization, data/analytics, and tech experts.