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Quality and Star Ratings

We know that achieving high Star Ratings, maintaining quality, and ensuring compliant risk scores are essential for the success of your health plan.

Let us help you accelerate your path forward. Explore a comprehensive set of solutions that will activate members, build loyalty, and give plan leaders data-informed strategies to improve quality, health equity, and Star ratings, promoting enterprise-wide alignment for long-term impact.

Address Star Ratings and overall quality performance with modularized solutions

When high Star ratings are crucial for your plan’s reputation and financial incentives.

Our solutions provide you with the intelligence and tools you need to improve your Medicare Star Ratings and overall quality performance across all lines of business.
We deploy a modular approach to provide adaptable solutions for your health plan, delivering value at every stage of your growth.

Member Rewards & Incentives

Intentionally designed solution to enable your plans in all markets to motivate, support, and reward members for completing healthy behaviors that support their health outcomes.

Address social determinants of health, morbidity capture, compliance requirements, and cost-savings.

Star Analytics

A web-based, interactive tool that empowers your plan with the ability to predict cut points, monitor performance, forecast projections, scenario plan, and establish probability analyses.

Inform the highest-value opportunities to improve your overall Star Ratings.

Capability Assessments

Assess enterprise-wide capabilities necessary for high Star performance against a maturity model across all functions of your plan.

Drive improvements in both risk and quality

Data, actionable insights, and expertise collide to optimize your risk and quality operations.

The Pareto Hub is a powerful big data analytic platform that transforms risk adjustment data into actionable insights. It supports end-to-end encounter data quality improvement and performance management across programs, campaigns, finances, and providers. With capabilities like financial accrual projections and prospective and retrospective member targeting, the Pareto Hub ensures compliance and proactive risk mitigation.
Our expert consulting services provide strategic qualitative and quantitative operational assessments, compliance and HCC risk mitigation policy development, and coding guideline review. We offer HCC validation audits and design risk adjustment programs, along with education and training modules. Our expertise in clinical documentation improvement (CDI) and best practice alert (BPA) ensures your plan is equipped to excel.

Maximize value and minimize trade-offs. Take a holistic view of your Star and risk adjustment data to establish high value actions.

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Bring it all together for quality

Integrating quality data and member risk profiles is critical to improving member experience, improving quality, and improving your risk adjustment gap.

This complete picture of members and their care needs means health plans can improve health outcomes sooner for individuals and populations.

Explore another solution to elevate your healthcare payer business.

Risk Suspecting & Adjustment
Pre-enrollment & Sales
Enrollment & Billing
Supplemental Benefits
Healthy Rewards & Member Engagement
Premium Integrity