Star Ratings Budget-Scenario Modeling

Medicare Advantage Star Ratings and other value-based care structures require integration between the quality, pharmacy and finance teams to ensure maximum health plan ROI. Quantify™ is the Adhere™ platform’s real-time analytics engine that integrates health plan quality gaps with financial budgeting processes – measure by measure. Quantify’s advanced analyses stratify and prioritize budgetary investment scenarios across each plan contract quality measure to maximize the aggregate Star Ratings and year-over-year quality improvement (Qi) factor.

Quantify’s data integration leverages machine learning and adaptive data preparation processing to aggregate HEDIS®, pharmacy claims, CAHPS and HOS datasets to provide population cohort analyses. Business analytics provide visualizations that overlay financial costs with benchmarked population predictive models using comparative data sets. Executive dashboards and ad hoc reporting enable health plan executive teams to work collaboratively with greater transparency to achieve greater Star Ratings.


Accountable Reporting

360 degree of performance reporting including consumer, provider and measure

Protect Bonus Payments

Stay on target with transparent performance impact and planning

Success Models

Build good, better, best scenarios to determine outcomes impact


Predictive Analytics

Real-time analytics generate predictive Star Ratings performance, including the simulated i-Factor measure boost

Resource Prioritization

Monthly insights into quality measure prioritization for improved overall Star Ratings performance with targeted consumer interventions

Engagement Strategy

Gap closure predictive modeling with consumer and provider-specific engagement analyses

Align Quality and Financial Strategies

Robust financial forecasting scenarios support team collaboration for quality measure intervention tactics

Has Your Health Plan Cracked the CMS Star Ratings Code?


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