Navigating the stars reset: An AI-first framework for improving medicare advantage ratings
The 2025 cycle saw plans absorb nearly $5 billion in lost bonuses. As CMS shifts focus to weighted clinical measures, legacy operational strategies are no longer enough to protect revenue and market position.
The game has changed. Strong member service operations can no longer compensate for gaps in clinical care. The new weighting of measures like readmissions and medication reconciliation means plans must re-engineer their approach or face significant financial and reputational consequences.
An AI-first strategy is the key to building a responsive, real-time ecosystem that improves clinical outcomes, enhances member experience, and delivers sustainable Star Ratings improvement.
Move from reactive tactics to a proactive, AI-powered Strategy
Stop relying on fragmented point solutions that only address symptoms. EXL’s integrated approach helps you build a closed-loop system that connects action directly to performance, empowering your teams to deliver measurable results.
- Protect revenue: Mitigate the financial impact of rating downgrades by improving the triple-weighted measures that matter most.
- Boost clinical efficiency: Deploy GenAI copilots and predictive models to help case managers identify and support high-risk members, reducing readmissions by up to 15%.
- Enhance member experience: Use AI-driven audits and omnichannel engagement to lift satisfaction scores and improve first-call resolution by over 20%.
- Scale with confidence: Implement a robust data and governance model to move AI initiatives from pilot to enterprise scale, ensuring compliance and continuous improvement.
Download your guide to a resilient stars strategy
The time for strategic reinvention is now. The plans that thrive will be those that embed AI, data, and human expertise at the heart of their improvement strategy.
Our whitepaper, "Navigating the Stars Reset: An AI-First Framework for Improving Medicare Advantage Ratings," provides an executive-level blueprint for action. Learn how leading plans are using AI to drive quantifiable gains and prepare for the future of value-based care.