We are proud to announce Eliza® Member Engagement is now part of Cotiviti!
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Track, predict, and model CMS Star Ratings and more for improved quality
Discover more in quality and performance
Within CMS’s Five-Star Quality Rating System for Medicare Advantage (MA) Part C and Part D programs, the stakes are high, with 42% of rated MA contracts earning a lower overall 2023 Star Rating year over year. High ratings yield significant benefits for a plan in the form of bonus payments, the ability to charge more than benchmark payments, and a leg up on marketing to and enrolling new members. Low ratings, in contrast, do not simply mean a plan fails to receive these benefits—it can face civil monetary penalties, suspension of marketing and enrollment activities, or even termination as an MA program.
$400
per member per year—that's the impact an increase of even half a star can have on a quality bonus.1
Introduced in October 2022, Cotiviti’s Star Intelligence gives health plans the ability to track, predict, and model their Star Ratings. This gives plans the capability to understand and prioritize actions needed to offer better care to a growing MA population and to optimize bonus payments.
Many plans may struggle to predict their Star Ratings for the current year and beyond, using homegrown solutions or Stars-specific offerings. But with Star Intelligence, plans can choose to integrate with our Quality Intelligence solution, ensuring consistency with historical HEDIS® data to support trending and projection logic, and take action with our Eliza® solution for better member engagement. This provides a more holistic view of members using a single source of truth for quality, Star Ratings improvement, member engagement, and more.