Supercharge Your Star Rating Improvement Efforts Using Machine Learning

Health plans have been working to optimize their performance with the Centers for Medicare & Medicaid Services (CMS) Star Rating Program for years. Organizations that prioritize Star Rating improvement tend to develop better processes, meet member needs more effectively, and increase member recruitment and retention — all of which can boost financial performance.

ML algorithms can be used to predict measure-level scores and cut-points for the coming year, generating realistic predictions up to the contract level. For measure-level score prediction, a regression paradigm is recommended with features that capture the essence of a contract’s historical performance and other details about the plan. For cut-point projection, there are a few possible options. One involves predicting all contracts for the upcoming year and replicating CMS’s cut-point calculation methodology.