Improve Stars, Risk, and Revenue, and Member Engagement with Proven Strategies
We provide insights to boost Star Ratings, improve risk adjustment accuracy, and proactively engage the highest need members to improve health outcomes. Our solutions integrate predictive analytics, quality improvement initiatives, and member engagement strategies. The result? Streamlined workflows, healthier outcomes, and accurate CMS revenue.
Star improvement in as little as one year
Strengthen Quality, Risk Adjustment, Encounter Data Accuracy, and Member Engagement
Medicaid managed care organizations (MCOs) face complex quality, risk, and cost challenges, from encounter data submission accuracy to fraud, waste, and abuse prevention. Pareto helps plans identify high-risk members, improve engagement through targeted outreach and incentives, meet state and CMS requirements, and strengthen operational performance with scalable solutions that deliver measurable, defensible results.
Recovered millions in improper payments for MCOs while meeting state audit benchmarks
Protect Revenue and Retain Members
For ACA Marketplace issuers, revenue protection, accurate risk score submissions, and member retention are mission-critical. Pareto supports risk score improvement and competitive member engagement—making it possible to compete effectively, control costs, and deliver better member experiences.
Recovery amounts as high as $50 per member through our proven Medicare COB processes
Strengthen Risk Performance, Payment Accuracy, and Population Health Outcomes
Risk-bearing provider organizations face growing pressure to capture risk accurately, improve care quality, and deliver measurable outcomes. Pareto Intelligence empowers provider groups participating in Medicare Advantage, ACA, and Medicaid with patient, provider, and contract level actionable insights, track RAF accrual, improve documentation accuracy, and ensure complete encounter data all supported by end-to-end operational expertise and real-world experience.
By combining data-driven analytics with operational support, Pareto helps organizations ensure accurate RAF, make informed decisions, and achieve better patient outcomes.
Actionable insights that support more accurate risk capture and stronger value-based performance.
Commercial health plans need analytics and engagement strategies that work seamlessly across multiple lines of business. Pareto provides a centralized analytics platform and expert advisory services that integrate enterprise data, streamline operations, and improve financial performance without adding operational burden.
On June 28th, 2019, the Centers for Medicare and Medicaid Services (“CMS”) released the Affordable Care Act (“ACA”) Risk Adjustment Transfer Payment results for the 2018 benefit year. Within days
With Pareto, compliance is built into the platform architecture and workflows. We deliver audit-ready documentation, data traceability, and integrated processes that align with CMS and state-specific requirements—reducing audit risk and administrative burden.
We map performance metrics directly to financial and quality goals. From revenue recovered to Stars improvement, every engagement includes outcome tracking, dashboards, and detailed reporting for full transparency.
Pareto implements in weeks, enabling our partners to derive in-year value from our actionable analytic solutions.
Pareto Intelligence is a healthcare analytics and technology company helping health plans in government-sponsored and commercial markets improve quality and financial performance. Our platform delivers actionable insights across premium reconciliation, risk adjustment, Star Ratings, payment integrity, and member engagement—so plans can recover revenue, close gaps, and stay CMS-ready.
We work with Medicare Advantage, Medicaid MCOs, ACA Marketplace, and commercial health plans to solve market-specific challenges. By combining predictive analytics, turnkey execution, and consultative expertise, we align every solution to the goals, compliance requirements, and member needs—helping health plans achieve measurable outcomes faster.
Fill out the form to take the first step toward reaching your goals. Share a few details so we can provide the right resources and support tailored just for you.
Fill out the form to take the first step toward reaching your goals. Share a few details so we can provide the right resources and support tailored just for you.
Fill out the form to take the first step toward reaching your goals. Share a few details so we can provide the right resources and support tailored just for you.
