Quality and CMS 5-Star Vertical

Quality and 5-Star Excellence

A unified quality command center to improve CMS 5-Star performance, HEDIS scores, and member experience with full auditability.

+0.5

Avg. rating improvement

Star Rating Readiness

See measure-level readiness, risk gaps, and performance trajectories.

85%

Automation rate

Quality Measure Automation

Automate HEDIS, CAHPS, and clinical quality measure aggregation.

Top 20%

Peer ranking target

Market Comparison

Benchmark against peers and identify competitive improvement opportunities.

Quality KPIs

Measure quality performance with auditable attribution and forward-looking insights.

+0.3

Star Rating

Improve 0.5-1.0

-24%

HEDIS Gaps

Close 20%+

+8%

CAHPS Lift

Increase satisfaction

99%

Measure Timeliness

Realtime visibility

Data Foundation

Build the quality layer on verified clinical, claims, and member data with governance across payers and providers.

Clinical Encounters & Outcomes
Quality Programs (HEDIS, CAHPS, CMS)
Member Enrollment & Attribution
Provider Performance
Claims & Risk Adjustment
Social Determinants of Health

Enterprise Controls

  • Measure definitions are versioned and fully auditable.
  • Governance for measure updates and release approvals.
  • Role-based access for quality, compliance, and leadership.

Core Capabilities

Everything quality teams need to manage measures and performance at scale.

Measure Library

Versioned CMS/HEDIS/CAHPS measures with governance.

Gap-to-Goal

Track measure deltas by contract, region, and provider.

Quality Forecasts

Simulations for star rating impact and interventions.

Audit Evidence

Traceable inputs and exports for compliance reviews.

Visual Snapshot

A clear, visual view of star performance and quality risk signals.

Quality & 5-Star Dashboard

Real-time quality analytics

Live Data

Measure Performance

Breast Cancer Screening
78%
Colorectal Cancer Screening
72%
Diabetes Care - A1C
81%
Controlling Blood Pressure
68%
Medication Adherence
84%

Star Rating Projection

Part C
+0.5
4.0
Part D
+0.5
4.5
Overall
+0.5
4.0

Gaps at Risk

Follow-up After ED Visit
234critical
Antidepressant Medication
189high
Statin Therapy
156medium
Transitions of Care
98low
Total open gaps677 members

Operational Playbooks

Guide executives and quality teams with prescriptive actions and performance forecasts.

Star rating simulations by contract and region
Strategic
Measure gap-to-goal tracking with drilldowns
Critical
Provider performance scorecards with attribution
High Impact
Puerto Rico market compliance support
Required

Visual Journey

Move from raw data to measurable 5‑Star outcomes in three steps.

1

Ingest & Normalize

Align claims, clinical, and member data to measure definitions.

2

Measure & Simulate

Evaluate measures and forecast star rating impact.

3

Act & Report

Track interventions and export compliance evidence.

Why Quality Teams Buy

Increase star ratings, close measure gaps, and align leadership on measurable outcomes.

Regulatory Confidence

Versioned measures with full auditability and governance.

Star Rating Lift

Simulations and gap-to-goal tracking across contracts and regions.

Operational Alignment

Shared dashboards for quality, compliance, and executive teams.

Deliver 5-Star Outcomes with Confidence

Monitor quality measures in real time, align stakeholders, and accelerate improvement.

Measure
Simulate
Achieve
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