New capabilities help Medicare Advantage organizations offer sustainable, high-quality plans by improving Star Ratings, strengthening RAF and reimbursement accuracy, and driving better member outcomes

 

RICHARDSON, Texas – June 30, 2026 – MedeAnalytics, the healthcare performance improvement company, today announced innovations to Medicare Advantage Insights, one of the core offerings of its enterprise healthcare analytics portfolio. These new capabilities help Medicare Advantage (MA) health plans unify fragmented data across quality, risk, finance, utilization, social determinants of health (SDOH), and member experience. By turning that data into predictive, prioritized insights and intelligent workflows, Medicare Advantage Insights helps plans improve financial performance, quality outcomes, and value-based care execution.

As the Medicare Advantage market continues to evolve amid regulatory change, margin pressure, and ongoing member movement, it remains a crucial growth and performance priority for many health plans.

“Medicare Advantage plans are under enormous pressure to improve Star Ratings, optimize RAF accuracy, manage medical costs, and enhance member experience—all while responding to rapid regulatory and market changes,” said Steve Grieco, CEO of MedeAnalytics. “With Medicare Advantage Insights, we’re helping payers unify critical data across the enterprise and surface the insights needed to act earlier, make better decisions, and improve financial performance and member outcomes. For example, one client had actionable insights in less than 10 days and experienced millions of dollars in value creation by unifying disparate data.”

Unlike fragmented point solutions that focus on individual domains, Medicare Advantage Insights is purpose-built for MA organizations while operating as part of MedeAnalytics’ market-leading enterprise analytics platform. This enables plans to connect quality, risk, utilization, member experience, provider performance, and financial performance in one integrated view.

“Before MedeAnalytics, it was tough to get a clear picture because our data was fragmented,” said a senior leader of quality and risk at a multi-state Medicare Advantage plan.  “Risk adjustment data was especially important for understanding the disease burden of new patients and planning our next steps. MedeAnalytics changed that instantly, giving us insights we wouldn’t have had otherwise and making everything so much easier to navigate.”

Medicare Advantage Insights has been shown to reduce time spent on quality reporting and submissions by up to 60 percent and reduce costs and time spent tracking utilization by up to 30 percent. It provides actionable insights across all functional domains to help improve Star Ratings, HCC coding accuracy, RAF optimization, care gaps, utilization trends, member satisfaction, provider performance, and financial metrics including premiums, subsidies, and CMS payments.

The platform's modular architecture enables payers to easily extend analytics beyond Medicare Advantage to Medicaid and Commercial lines of business, supporting enterprise-wide analytics strategies while improving care for dual-eligible populations. Built on Health Fabric™, MedeAnalytics’ proprietary health data management platform, and industry-leading cloud technologies including Amazon Web Services (AWS) and Snowflake, enables health plans to rapidly deploy new populations and scale analytics capabilities to meet the needs of organizations of any size.

One platform. Complete Medicare Advantage visibility.

Medicare Advantage Insights centralizes data from CMS Medicare Advantage files (MMR, MOR, and MAO-004), claims, clinical systems, provider data, surveys, and operational sources to provide a comprehensive view of plan performance, helping plans:

Optimize risk adjustment and revenue by proactively identifying documentation and coding gaps and monitoring premiums, subsidies, payments, and risk scores.

Improve Star Ratings and quality performance by tracking quality measure performance in real-time and identifying care gaps and intervention opportunities.

Manage population health proactively by more precisely identifying and segmenting high-risk populations, reducing avoidable utilization and hospitalizations using AI-driven analytics, enabling early interventions.

Enhance member experience and retention by analyzing member satisfaction and engagement, identifying churn risks and experience gaps, and monitoring CAHPS-related performance drivers.

Optimize cost and operational performance by forecasting costs and utilization trends, evaluating provider performance and network adequacy, and streamlining regulatory reporting and monitoring.

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