Abacus Insights Stars Performance Data Solution

Improve and Maintain High Quality and Star Ratings with Insights-Ready Data™

Reaching the top echelon of quality for Medicare Advantage plans with 4.0 or higher Star Ratings is a strategic driver for payers. By attaining 4 stars, payers trigger a 5% quality bonus payment per plan that can fund additional member benefits and programs to attract and retain beneficiaries.

Moving from 3.5 to 4.0 stars can add up to $62.5 million in annual quality bonus payments per Medicare Advantage contract

Estimate based on a Medicare Advantage plan with 150,000 members and an average quality bonus of $417 per enrollee for 2023.

Payer success begins with usable data. Our Stars Performance Data Solution provides insights-ready data™ built on a foundation of usable data that is accurate, complete, timely, relevant, versatile and tailored with stars data.

Single Integrated View Provides Visibility at the Measure, Member, Provider, and Contract Levels

With a single integrated view of stars performance for each contract, including HEDIS, Part D, CAHPS, HOS and CMS Operations measures, the data solution eliminates the payer burden of wrangling data from multiple sources and manually integrating results across vendors and formats.

The Stars Performance Data Solution delivers on-demand insights-ready data™ at the measure, member, provider, and contract levels, including:

Projected Cut-Points. Understand thresholds for each quality measure and overall contract-level Stars performance.
Rx/Part D Measures. Track member-level medication adherence rates and maintain a pulse on opportunities for outreach and education.
HEDIS Measures. Monitor effectiveness of care and preventive screenings for HEDIS/Star Ratings measures.
CAHPS Member Experience. Maintain visibility into the drivers of member experience while also tracking quality performance and the effectiveness of initiatives in boosting Star Ratings.
CMS Adjustments. Incorporates Categorical Adjustment Index (CAI), the Reward Factor and Quality Improvement measures for increased precision and accuracy in the calculation of predicted contract-level Star Ratings. These important adjustment factors can move overall Star Ratings by .5 stars. The data solution will incorporate the Health Equity Index, replacing the Reward Factor, to reflect the 2027 Star Ratings change.

Abacus Insights’ Stars Performance Data Solution empowers confident decision-making for targeting limited resources on priority interventions to improve quality and member and provider experience.

Access

complete, accurate, timely, flexible, versatile, and use case-specific data in a secure cloud environment.
Gain

a single, integrated view of stars performance with usable data, measures, and core analytics.
Align

Star Ratings program visibility across the organization to prioritize focus and resources on interventions with the greatest impact on stars performance.
Accelerate

routine delivery of on-demand, core analytic insights for HEDIS, Part D rates, member experience and CMS administrative measures to enable focus on advanced analytics.
Automate

distribution of results in preferred formats – extract, BI tools, analytics or AI platforms, APIs, real-time stream.
Receive

annual updates to include new measures and analytics along with testing and data validation.