In the complex landscape of healthcare, the CMS Star Ratings program offers substantial financial benefits, including bonuses, rebates, and increased member enrollment. However, the program’s dynamic nature—marked by ever-changing measures, weights, and cut points—presents a challenge for Payers. Enter Perform+ Stars, an AI/ML-based decision engine. It tackles this challenge head-on by providing enhanced data clarity and streamlined decision support for Star measures. By combining healthcare expertise, data science proficiency, and an Embedded Intelligence framework, Perform+ Stars drives significant improvements across the clinical value chain, ensuring a comprehensive enhancement of Star ratings.

• Measure analysis Get detailed visibility on current, projected, and goal ratings with inbuilt tabular and graphical views. Use what-if analysis to predict the impact of changes in ease of closure, cost, and available manpower.

• List prioritization Access a detailed view of prioritized Providers and Members with high potential for performance improvement. Filter Members and Providers for each Star goal based on impactability and likelihood of engagement.

• Recommendation engine Utilize an AI-powered recommendation engine for end-of-year performance projections based on historical trends and current performance. Get recommended goals for Star ratings, including ease of closure, cost of closure, and available resources.