Star Intelligence

Track, predict, and model CMS Star Ratings and more for improved quality

CMS RAC

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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.

Key Star Ratings metrics affecting MA plans include:

>100%

growth in number of plans available to the average Medicare beneficiary between 2017 and 20222

5%

revenue bonus is awarded to plans that earn 4 stars or higher, as well as higher rebates to use toward richer supplemental benefits for members3

>80%

of all MA enrollees are in plans that receive a bonus payment based on Star Ratings4

Star Intelligence solution benefits and features

Facing increasing competition and a reversal on flexibility in ratings and measures from the COVID-19 pandemic, plans are facing a multitude of challenges when it comes to improved quality. Star Intelligence can help plans to overcome these challenges, enabling them to:

  • Integration. Access a one-stop shop for HEDIS quality and Stars management, improving integration and consistency
  • Comprehensive Reporting. Get a clear view of progress with easy-to-view dashboards that feature trending and benchmarking to support plan communications on gaps and opportunities
  • Predictive Analytics. Leverage analytics that offer measure prediction, end-of-year contract rating predictions, trends, and opportunities for growth
  • Predictive Cut Points. Get reliable predictive insights on the volatile cut point ranges determined by CMS per national trends

Work with a solution that stands apart

From working with experienced experts to scalable integration possibilities, Star Intelligence helps your organization improve quality with:

  • Consulting services to help identify missing data sources, areas of improvement, and market trends to improve Star Ratings
  • A comprehensive view of measures in and across contracts
  • Integration with an industry leading, best-in-class, NCQA-certified HEDIS vendor and a leading consumer engagement solution
  • Operational gains from utilizing a single source of truth and managing a single data feed

Discover more in quality and performance

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