Medicare Advantage Performance Solutions

Improving Star Ratings, CAHPS, and Network Performance Through Provider Transformations

The Challenge

Medicare Advantage plans struggle to improve performance because the drivers of Stars & CAHPS sit within provider workflow – not at the health plan level.

Common barriers include: Underperformance on key Star measures; Declining CAHPS and member experience scores; Limited provider engagement capacity; Strong data insights without operational execution.

Our Solution

Elevation Health delivers provider-led performance transformation at scale to reach 5 Star performance. In fact, we are so good at this, we go at risk for priority measures. We activate provider networks, redesign workflows, and embed performance management across defined populations (~10,000 members).

We combine provider engagement and coaching, workflow transformation, data-driven performance management, and The IHI Breakthrough Series™ improvement model.

Core Service Offerings

Each program targets a critical driver of provider performance and can be deployed independently or as part of an integrated solution.

STAR-R

Stars Recovery & Resilience

Clinical Quality and Star Ratings Performance + QBP revenue

  • Measurable improvement in high-impact measures (e.g., BP control, diabetes, medication adherence)
  • Activates provider workflows to drive Stars performance
  • Protects and grows Quality Bonus Program (QBP) revenue
  • Enhanced sustainable operational capabilities for provider engagement staff
outcome

Measurable improvement in Star Ratings and clinical quality performance

VOICE

Value & Outcomes Innovation for Consumer Experience

CAHPS scores and Member Experience

  • Increases net new appointment to your members
  • Enhances provider to member communication and engagement
  • Redesigns scheduling, care coordination, and patient engagement workflows
  • Embeds experience-driven behaviors (e.g., AIDET, service recovery)
  • Addresses root causes of poor CAHPS performance
outcome

Improved CAHPS scores, member satisfaction, and retention

PASCE

Pharmacy / Medication Adherence Enhancement (Emerging / Modular)

Medication Adherence and Pharmacy Integration

  • Enhances adherence measures across Star Ratings
  • Integrates pharmacist-led interventions and MTM-aligned workflows
  • Can be deployed standalone or embedded within STAR-R / VOICE
outcome

Improved adherence measures and clinical outcomes

Explore Pharmacy Quality Improvement →
 

How We Deliver

We’ve designed a standardized, repeatable transformation model for multi-year performance improvement change:

1. Governance and executive alignment

2. Population and provider targeting

3. Data-driven gap analysis

4. Provider recruitment & activation

5. Structured learning collaboratives using The IHI Breakthrough Series™ model

6. Performance tracking and reporting

7. Sustainability and handoff

Typical Client Use Cases
When to Engage Elevation Health
Typical Client Use Case Star Ratings below or at risk of falling below 4 Stars
When to Engage Elevation Health Reach 4 and 5 Stars on priority measures and protect QBP revenue
Typical Client Use Case CAHPS scores or Member Experience Decline
When to Engage Elevation Health Redesign workflows that impact access, communication, and satisfaction
Typical Client Use Case New Market or Product Expansion
When to Engage Elevation Health Rapidly deploy quality infrastructure and performance systems
Typical Client Use Case Data-Rich but Poor Execution Environments
When to Engage Elevation Health Translate insights into accountable operational improvement

The Impact

“The project offered fresh perspectives on meeting HEDIS measures and supporting staff, like using AIDET and providing extra clinical training. For medication adherence, establishing a workflow using both call and text reminders helped keep the patients on track.”

CAHPS Survey scores

Boosted Star Ratings

Increased likelihood of achieving / maintaining 4+ Stars

In all measures of focus, the distribution of star performance shifted, with more providers achieving high star ratings compared to baseline.

In 5 measures of focus, the enrolled providers outperformed the non-enrolled provider cohort.

Long-Term Impact

Strengthened provider network performance

Sustainable operational capabilities within the health plan