Medicare Advantage Insights
Payer enterprise analytics for your Medicare Advantage member population
Medicare Advantage plans need a unified, trusted view of member-level performance across quality, risk, SDOH, and financial metrics
Today, data is fragmented across these domains, limiting visibility into key drivers of Star Ratings, RAF accuracy, and cost performance. This fragmentation leads to missed revenue opportunities, slower decision-making, and reduced ability to respond to regulatory changes or sustain profitable growth.
“By day ten, I received an in-depth analysis on HCCs, along with additional analytics from [MedeAnalytics] that completely exceeded our expectations. One of our executive team members even remarked, 'We didn’t expect to see everything so quickly.' This rapid turnaround was crucial for us as a new plan. Without historical data to rely on, having immediate insights allowed us to understand our performance and chart the path forward. The value we gained from this was immense.”
Senior Manager, Risk Adjustment & Quality Improvement, Medicare Advantage Health Plan
Move from multiple-vended point solutions to one unified data platform
Get a complete view of your Medicare Advantage members and plan performance with unified data and analytics across quality, risk, cost, SDOH, and experience to:
- Improve HCC coding accuracy
- Close care gaps
- Improve Star Ratings
- Optimize network and cost management
- Improve value-based care contracts
Key benefits of the MedeAnalytics Medicare Advantage enterprise analytics solutions
Prevent hospitalizations and improve health outcomes with targeted interventions and personalized care using analytics to segment members based on risk.
- Ensure accurate Hierarchical Condition Categories (HCC) coding and risk adjustment by identifying gaps in documentation and coding
- Prevent hospitalizations and improve health outcomes with targeted interventions and personalized care using analytics to segment members based on risk
- Gain a comprehensive and unified view of member and provider information by centralizing diverse and siloed data such as claims, electronic health records, member surveys, and provider reports
- Achieve higher Star Ratings and improve HEDIS quality measures with targeted interventions through analytics that help track and analyze performance across various quality measures
- Reduce compliance risks and streamline regulatory processes with continuous automated reporting and auditing
- Enhance member satisfaction and reduce churn with insights into member behavior, preferences, and satisfaction levels
Unify your cross-domain Medicare Advantage data for improved interoperability and plan performance
Medicare Advantage health plans with fragmented data across risk, quality, cost, and member experience may struggle with limited revenue, lower Star Ratings, and constrained growth. Our product is an integrated data and analytics platform that delivers a unified, real-time view to optimize HCC coding, improve quality performance, manage costs, and enhance member outcomes. Unlike siloed point solutions or manual reporting, we connect risk, finance, SDOH, and quality insights in one trusted system for faster, more informed decisions.
Analytics in action
Star Ratings Dashboard: Enhance overall health plan performance to achieve higher Star Ratings and improve quality measures.
Provider Scorecard: Ensure that provider networks are adequate, high-quality, and compliant.
HEDIS Meaures Dashboard: Reduce compliance risks with streamlined regulatory processes and automated reporting and monitoring.
High-Cost Claimants Dashboard: Manage your highest-cost members with early identification, segmentation, and tracking.
Learn more about how your analytics can drive action
eBook
From good to great: Eight steps to improve Medicare Advantage Star Ratings
Most Medicare Advantage plans know what it takes to improve Star Ratings, but moving from “good” to “great” requires more than incremental change. Fragmented data, reactive strategies, and disconnected workflows make it difficult to drive consistent performance and member outcomes. Our new eBook outlines a practical, data-driven framework built on integrated analytics, real-time performance monitoring, predictive insights, and targeted interventions to help plans close gaps, elevate member experience, and achieve sustainable 4+ Star success. Download the eBook
Blog post
Why “good” isn’t good enough: The hidden cost of sub-4 Star Medicare Advantage performance
Health plans that fall below 4 Stars can lose approximately 5% in Quality Bonus Payments, along with an estimated $300–$400 per member per year in additional revenue tied to quality performance. At scale, that translates to losses of up to hundreds of millions of dollars. Closing the gap between Star Ratings tiers requires a new approach that unifies data, intelligence, and action to drive measurable performance improvement. Learn more
Blog post
How is telehealth impacting Stars performance?
Stars scores are a critical component of success for Medicare Advantage plans, MSSP and REACH ACOs, driving them to maximize the amount of shared savings realized and attract Medicare beneficiaries to enroll in high-quality care plans. In fact, plans with a Stars score of 4.0 or higher accounted for 71% of Medicare Advantage in 2023. Patient satisfaction has been cited as the most integral element in the success of telemedicine implementation, adoption, and ongoing success. Learn more