For Health Plans & MCOs

"We're stuck at 3.5 stars. Need to reach 4.5+ to maximize CMS bonuses."

Real-time HEDIS tracking, automated member outreach, and predictive star rating modeling help health plans improve 1.5-2 stars in 18-24 months while earning $650K-$1.2M in annual quality bonuses.

The Star Ratings Crisis

CMS star rating changes are devastating health plan revenues—and most plans don't see it coming until it's too late.

$88B
Preventable complications annually
178 days
Average gap between visits
$1-3B
Humana's star rating loss
$375M
Elevance penalty (0.0003 difference)
69
MA contracts lost bonuses (2024)
0.5 stars
Drop = $200-500M loss

How We Solve It

Five integrated solutions that work together to boost star ratings and maximize quality bonuses

Our Solution

1

Real-Time HEDIS Tracking

Live dashboard of all quality measures updated after every healthcare event

  • Patient status updates within seconds
  • 65+ quality measures tracked
  • Continuous scoring, not annual
2

Member Gap Lists

Automated identification and prioritization of care gaps by measure

  • AI-prioritized interventions
  • Exportable outreach lists
  • Real-time gap closure tracking
3

Provider Scorecards

Distribute performance data to your network providers automatically

  • Practice-level dashboards
  • Benchmarking across network
  • Actionable feedback loops
4

Automated Outreach

Member communication campaigns triggered by care gaps

  • SMS/email/phone workflows
  • 75-85% contact rates
  • Documented interventions
5

Predictive Modeling

6-month advance warning of star rating changes

  • 95% prediction accuracy
  • Measure-level drill-down
  • What-if scenario planning

Typical Results for 500K Member Health Plan

Based on actual customer outcomes over 18-24 months

Star Rating Improvement

Before:3.5 stars
After:5.0 stars
1.5-2 star increase in 18-24 months

Quality Bonuses Earned

Before:$0
After:$650K-$1.2M
Annual recurring bonuses

Member Retention

Before:80%
After:92%
15% improvement

Staff Time Reduction

Before:40 hrs/month
After:7 hrs/month
60% time saved on reporting

Calculate Your Organization's ROI

See your potential savings and quality bonuses based on your member count

ROI Calculator

Health Plan - Calculate Your Potential Return

Success Stories

Regional Health Plan

Medicare Advantage500K members

Challenge

"We were stuck at 3.0 stars for 3 years. Needed 4.0+ for CMS bonuses."

3.0→5.0

Star Rating

$800K

Quality Bonuses

60%

Faster Gaps

88%

Time Saved

"The real-time quality gap identification helped us improve member care while earning significant bonuses. We're now a 5-star plan."

Sarah Chen

VP of Quality Operations

Implementation Timeline
Implemented in 8 weeks, first improvements visible in 4 months, 5-star rating achieved in 12 months

Weekly Care Gap Outreach: Before & After

See how automation transforms manual quality workflows

Manual Process

20 Hours/Week

4 hrs

Generate reports

Pull data from multiple systems, merge in Excel

4 hrs

Prioritization

Manual review to identify high-value members

10 hrs

Outreach calls

50-100 manual calls per week

2 hrs

Documentation

Update spreadsheets with call outcomes

Result: 30-40% contact rate, gaps close too late

With HEDIS LIVE

2 Hours/Week

5 min

Auto-generated lists

AI prioritizes by predicted STAR impact

5 min

Launch campaigns

One-click automated SMS + call workflows

1 hr

Monitor responses

Real-time dashboard tracks engagement

50 min

High-value follow-up

Only call members who need personal touch

Result: 75-85% contact rate, gaps closed proactively

Time Saved Per Week

18 hours (90%)

Enterprise-Grade Security & Compliance

HIPAA Compliant + BAA
SOC 2 Type II Certified
NCQA Measure Certified
AES-256 Encryption
99.9% Uptime SLA
CMS Approved

Trusted by health plans nationwide to protect PHI and maintain regulatory compliance while maximizing quality performance.

Don't Leave Quality Bonuses on the Table

Join health plans earning $650K-$1.2M in annual quality bonuses with real-time HEDIS tracking and predictive star rating modeling.