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New Cotiviti Solution Enables Health Plans to Predict and Improve Medicare Advantage Star Ratings

October 10, 2022

SALT LAKE CITY--(BUSINESS WIRE)--Cotiviti, a leader in data-driven healthcare solutions, has launched Star Intelligence for Medicare Advantage payers, marking the latest addition to its industry-leading Quality and Stars solution suite. This new solution gives plans the ability to track, predict, and model their Star Ratings to better understand and prioritize actions needed to offer high-quality care to a growing Medicare Advantage population as well as optimize bonus payments. An increase of half a star improves a plan’s quality bonus by an average of $400 per member per year, according to one recent analysis1.

New @Cotiviti solution enables Medicare Advantage plans to predict and improve Medicare Advantage Star Ratings

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“For Medicare Advantage plans, the importance of achieving a Star Rating of four or higher cannot be overstated—and makes a significant impact on member recruitment and retention,” said Emad Rizk, M.D., chairman, president, and CEO of Cotiviti. “In the wake of COVID-19, the Centers for Medicare & Medicaid Services (CMS) introduced several provisions that led to an unprecedented improvement in Star Ratings for plans across the country. With the temporary changes now removed and a more accurate methodology for documenting plan performance reestablished, many plans saw lower performance in the recently released 2023 Star Ratings. Amid these challenges, Medicare Advantage plans need a powerful tool such as Star Intelligence to regain their footing and find the most direct path to improvement.”

Cotiviti’s Star Intelligence gives plans a deeper understanding of their Star measures performance to enable improvements. The solution leverages advanced predictive analytics, highlighting opportunities for growth through predictive cut points, measure predictions, and end-of-year contract rating predictions. Transparent, easy-to-view dashboards with trending and benchmarking enable comprehensive reporting to better support plan communications on gaps and opportunities. When integrated with Cotiviti’s Quality Intelligence solution, Star Intelligence also provides a one-stop shop for HEDIS® quality and Star Ratings management, which eases setup, maintenance, and ongoing training costs; streamlines integration; and delivers consistency across quality programs.

Cotiviti complements its leading technology with expert advisory services. A Star Ratings analyst with a deep understanding of the measures and their financial impact provides clients with personalized support. These consultative services include interpreting results, benchmarking, and delivering actionable insights. Cotiviti’s support enables plans to target member gaps and opportunities across multiple Star Ratings measures to improve quality and reduce member and provider abrasion.

“As new Medicare Advantage plans enter the market and consolidation accelerates among the players, competition is increasing and health plans are putting even greater investment in achieving the highest Star Ratings possible,” said RaeAnn Grossman, executive vice president of population health management, risk adjustment, and quality operations for Cotiviti. “Health plans leveraging home-grown or siloed offerings struggle to predict their standing and next best action. These organizations need a robust, tactic-focused, and predictive solution to support them in meeting their Star Rating goals today and planning for the future.”

Health plans hoping for a more comprehensive level of support can choose to integrate Star Intelligence with Quality Intelligence, ensuring consistency with historical HEDIS® data to support trending and projection logic. Plans can also expand their value with Cotiviti’s Eliza® solution, which integrates with Quality Intelligence, for better member engagement. This combination provides a more holistic view of members using a single data ingestion process and source of truth regarding quality, Star Ratings improvement, and member engagement. Plans can then use this information to optimize departmental processes and procedures and improve project management efforts to strategically manage member health.

About Cotiviti

Cotiviti is a leading solutions and analytics company that is reshaping the economics of healthcare, helping its clients uncover new opportunities to unlock value. Cotiviti’s solutions are a critical foundation for healthcare payers in their mission to lower healthcare costs and improve quality through higher performing payment accuracyquality improvementrisk adjustmentconsumer engagement, and network performance management programs. The company also supports the retail industry with data management and recovery audit services that improve business outcomes. For more information, visit

HEDIS® is a registered trademark of the National Committee for Quality Assurance.


Jennifer Brooks
Aria Marketing for Cotiviti