The Health Plan Member Who Stopped Picking Up
When quality, risk adjustment, and rewards teams reach out separately, members can feel less like patients and more like names on a call list. This article explores how coordinated, personalized rewards can reduce outreach fatigue while supporting stronger member engagement, risk adjustment performance, and Star Ratings.
Building a Resilient Star Strategy When the Rules Keep Changing
CMS changes can make Star performance harder to predict. Kimberly Switlick-Prose explains how Medicare Advantage plans can balance near-term measure improvement with the capabilities, scenario planning, and probabilistic forecasting needed to adapt.
The New RADV Reality: What Health Plans Need to Do Now
Explore key strategies from the Your RADV Game Plan and discover how health plans can navigate the evolving CMS RADV environment with stronger analytics, documentation, retrieval, and operational readiness.
What Is Star Year 2027 CAHPS Data Really Telling Medicare Advantage Plans?
National CAHPS performance barely moved for Star Year 2027. The more revealing story is happening state by state. Pareto Intelligence examines what the public data says about the planning context Medicare Advantage plans need to understand.
The Pareto Effect on Two Clients’ HHS-RADV Performance
When two ACA issuers faced the same audit cycle with different levels of RADV support, the financial gap between them reached into the millions, making this a must-read for any issuer preparing for the next audit cycle.
CMS’ Race to Validate: Navigating the Rapid RADV Era
CMS has launched its Payment Year 2020 Contract-level RADV audit process, giving selected Medicare Advantage health plans access to sampled members and HCCs — with PY2021 audits expected to begin as early as May 2026, creating an unprecedented situation where plans must manage multiple concurrent audits across different payment years. Pareto helps health plans navigate this high-pressure environment by offering prioritized chart retrieval, certified medical coding audits, end-to-end project management, and financial impact quantification — turning a complex compliance sprint into a structured, manageable process.
The Real Job of a Star Ratings Team
A C-Suite leader once asked: “So why does the Stars team need to exist?” They don’t close gaps, chase charts, or run the call center. But in the real world of MA, that team may be the difference between paralysis and performance.
The 3 Biggest Star Takeaways From The 2027 MAPD Rule
The 2027 MAPD Rule is removing 11 Star measures, and the ones being cut are largely the highest-performing ones. This article breaks down what that means for health plan performance, and where leaders should focus their energy in response.
Pareto Intelligence Launches StarIQ to Bring Predictive Intelligence to Medicare Advantage Star Ratings
Pareto StarIQ is a predictive intelligence platform designed to help Medicare Advantage plans leverage predictive insights to execute their best path toward Star Rating improvement.
PY2027 Advance Notice Deep Dive: Impact of Unlinked Supplemental Submissions
CMS proposes eliminating unlinked supplemental records for Medicare Advantage in 2027, but the critical challenge is that official guidance on how to link supplemental encounters to claims has never been published for the MA market. This ambiguity has led to widely varying linking methodologies across plans. This deep dive breaks down the complexities and provides actionable steps for MAOs to navigate this regulatory change.