Optimizing Medicare Plan Performance 

Focus on improving the member experience and close gaps in care, specifically HEDIS measures like annual wellness visits, diabetes eye exams and other cancer screenings.

Engage providers and share star ratings, align incentives with provider contracts, and offer real-time data at the point-of-care to improve quality experience and patient outcomes.

Start with a root cause analysis to understand why your plan is in decline. Do you have enough provider coverage in your network? What do your star ratings tell you?

Don’t lose sight of member retention. Use tools like predictive analytics to understand “at-risk” members for proactive outreach and intervention strategies.

Build a competitive, highly targeted benefits plan for your market. Use data to understand the community needs, including SDOH data, to understand growth pockets who are underserved.

Show up in the community and engage trusted community influencers.

Engage providers and brokers with clear, actionable strategies backed by advanced analytics to ensure quality performance and better outcomes.

Strengthen operational infrastructure and find the right data management and advanced analytics partner to support your growth at scale.

Expand provider networks and ensure they have enough support and understand your expectations (HEDIS, RAF, CAHPS).

Build real-time visibility and reporting to manage growth. Growth can’t be tracked with stale data, nor can you ensure compliance. Invest in systems before you need them. Poor technology cost is exponentially higher under rapid growth.