SOLUTION BRIEF

StarZS: Enabling
Medicare Advantage
plans to consistently
achieve high performance
BackgroundOur approach

The Centers for Medicare & Medicaid Services’ (CMS)Star Ratings program is crucial to health plans oﬀering
Medicare Part C and Part D coverage, as it ties ﬁnancial
incentives to performance. Despite this, health plans
continue to face challenges today due to a variety offactors, such as evolving policies based on member
needs, diverse domains for evaluating quality of careand siloed processes that lack a holistic strategy toimprove star ratings.

ZS addresses these challenges through a set of
guiding principles that can help health plans
improve on Star Ratings:

There is a need for a solution that addresses thesechallenges by prioritizing measures for interventions
that drive high performance, as well as optimizing
resources by targeting members for interventions with
impactful outcomes. Medicare Advantage (MA) plans
require a solution that eﬀectively tackles last-mile
execution through provider activation, member
engagement and other touchpoints.
This is why we have developed StarZS, a suite ofsolutions that integrates data across all service
providers, enabling agile decision-making.

1. Strategy: Our approach combines analytics andindustry expertise to help clients develop acustomized Stars strategy
2. One Data Platform: We work with plans andtheir service providers to aggregate Stars data
into a single platform, enabling plans to track
Star performance and make informed decisions.
3. Integrate insights to the workﬂow: We use
advanced AI and machine learning (ML)based analytics techniques to generateactionable insights, empowering plans tofocus on high-impact areas and optimize
resource allocation.
4. Last mile execution: Our "analytics to impact"solutions activate strategic priorities on Star
Ratings and drive lasting behavior changes.

SOLUTION BRIEF

Our Solutions
The StarZS suite of solutions consists of four solutions that leverage AI/ML-backed insights to empower health plans
identify areas of opportunities that impact their Star Ratings and take actions based on a consistent performancemonitoring strategy.

StarZS Planner

StarZS Monitor

The StarZS planner oﬀers dynamic goal setting,allowing users to choose high-impact and low-eﬀort
measures for improvement. The dashboards ensure asingle source of truth, with synced information acrossall vendor data sources—meaning all the data isreproducible, transformative and can be used tobenchmark performance for contracts.

As the single source of truth, the StarZS Monitor
dashboard enables transparency across theorganization with synced information across all datasources and service providers.
FIGURE 3: The StarZS Monitor dashboard shows acontract's performance overview

FIGURE 1: The StarZS Planner helps visualize
measure prioritization

FIGURE 4: The StarZS Monitor dashboard also
shows score trends analytics
FIGURE 2: StarZS Planner simulation output example

StarZS Member and Provider Engagement
StarZS Interventions Design
The intervention toolkit identiﬁes drivers of measureperformance using AI/ML based analytics and aids
design of focused interventions.

The solution helps health plan healthcare
operations and quality management teams withinsights and capabilities to deliver the last mile ofmember and provider engagement opportunities
with turnkey insights and rich data sources.

SOLUTION BRIEF

Creating real world impact
ZS has deployed StarZS assets for various use cases of Star Ratings to diﬀerent health plans so far:Case study No. 1: Star Rating decline

Case study No. 2: Lagging behind

A medium-sized Blues health plan saw a consistentdecline in the Star Ratings of its key Medicare
Advantage prescription drug plan (MAPD) contract,which catered to the bulk of its MA enrollments. ZS
leveraged StarZS Planner for prioritizing measures forinterventions, and deployed StarZS Monitor to track
performance for the prioritized measures, helping theplan to create member cohorts for interventions
based on measure compliance.

A major national health plan was lagging on
triple-weighted medication adherence measures,
scoring three-stars in the 2023 Star Ratings. We
leveraged the StarZS Intervention Design solution to
design the interventions by creating patient journeyarchetypes and isolating drivers of performance gaps.

Results• 11 recommended measures for performance

improvement, improving contract Star Rating from
3.5 stars to 4.5 stars.

Results• Achieved potential an approximately 1% lift inadherence measures, increasing the number offour-star contracts for each measure.

• Designed interventions for each adherence barrier
identiﬁed, along with opportunities to implement
these techniques.

• Created member cohorts to improve performancefor prioritized measures.

Learn more: https://www.zs.com/industries/health-plans

About ZSZS is a management consulting and technology ﬁrm focused on transforming global healthcare and beyond. We leverage ourleading-edge analytics, plus the power of data, science and products, to help our clients make more intelligent decisions, deliver
innovative solutions and improve outcomes for all. Founded in 1983, ZS has more than 13,000 employees in 40 oﬃces worldwide.

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