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PLATFORMS

Stars Decision Engine

Leverage AI/ML to improve CMS Star Rating

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SDE_Member

SDE (Stars Decision Engine): Overview

Higher CMS Star ratings have significant financial benefit for Medicare Advantage plans, in the form of bonuses, rebates and stronger member enrolment. However, the dynamic and complex nature of the CMS Star program makes it difficult for health plans to strategize improvement programs, as the measures, weights, and cut-points are moving targets that keep changing every year.

CitiusTech’s Stars Decision Engine (SDE) is an AI/ML based solution that enables health plans to obtain better data clarity and streamline decision support for Star measures. The solution combines our healthcare expertise, data science proficiency, and Embedded Intelligence Framework to deliver substantial improvements across the clinical value chain, ensuring holistic Star rating improvement.

SDE (Stars Decision Engine): Advantage

CitiusTech Stars Decision Engine Stars Decision Engine leverages the power of Machine Learning and Artificial Intelligence to help health plans with:

PERFORM  Unified View

Single view of Performance

Track performance across all contracts along with performance trend & benchmarks

MRR

End-of-Year Performance Projection

Specialized dashboards to help identify target measures and align goals

FAST  CMS Compliance

Pre-built Models & Out-of-the Box Capabilities

Pre-built use cases – Contract Simulator, Network Optimizer and Incentive Designer

BIC-Audit 360

ROI-based Scoring for Outreach

‘What-if’ analysis of influencing factors and suggestions on optimal path to reach Stars goals

Rules Manage

Prioritized Provider & Member Lists

Lists aligned to Stars goal, having high potential for performance improvement

PERFORM  Self-service Capability

Intuition-driven Goal Identification

Takes into account business intuition for optimal resource & budget planning

PERFORM  Unified View

Single view of Performance

Track performance across all contracts along with performance trend & benchmarks

MRR

End-of-Year Performance Projection

Specialized dashboards to help identify target measures and align goals

FAST  CMS Compliance

Pre-built Models & Out-of-the Box Capabilities

Pre-built use cases – Contract Simulator, Network Optimizer and Incentive Designer

BIC-Audit 360

ROI-based Scoring for Outreach

‘What-if’ analysis of influencing factors and suggestions on optimal path to reach Stars goals

Rules Manage

Prioritized Provider & Member Lists

Lists aligned to Stars goal, having high potential for performance improvement

PERFORM  Self-service Capability

Intuition-driven Goal Identification

Takes into account business intuition for optimal resource & budget planning

SDE (Stars Decision Engine): Core Modules

The Stars Decision Engine covers an exclusive library of data and analytics use cases for health plans, augmented by Consulting, Engineering Services and Data & Analytics expertise.

Measure Analysis

Inbuilt tabular and graphical views to provide detailed visibility on current ratings, Projected ratings and Goal ratings. What-if analysis to predict the impact of change in ease of closure, cost, available manpower, etc.

List Prioritization

Detailed view of prioritized providers and members that have a high potential for performance improvement. Easy to filter members and providers for each star goal based on their impact-ability and likelihood of engagement.

Recommendation Engine

AI-powered Recommendation engine that provides end-of-year performance projections based on historic trends and current performance. Also makes available recommended goals for Star ratings, with additional details such as ease of closure, cost of closure and available resources.

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