Star Engine
Stars Decision Engine is an AI/ML- (what if analysis) powered solution designed to help Medicare Advantage Plans improve CMS Star Ratings through predictive insights and data-driven decision-making. By integrating embedded intelligence, it enables payers to prioritize interventions, optimize performance, and drive sustainable quality improvements.
US Healthcare
UX Designer + Researcher
Data Science, SMEs, Product Stakeholders
Challenge
Medicare Star Ratings significantly impact health plans' financial performance and consumer trust. However, payers struggle with:
Fragmented insights: Siloed data across contracts, providers, and members.
Unclear prioritization: No structured way to allocate efforts for maximum ROI.
Lack of predictive intelligence: Difficulty in estimating end-of-year Star scores.
Outcome and Impact
Achieved a 4+ CMS Star Rating
Closed 3× More Gaps through AI-powered prioritization
Enabled Smarter Decision-Making with predictive analytics
Industry Recognition:
"The solution was co-developed with FluidEdge Consulting and featured as a breakthrough AI-powered healthcare tool by CitiusTech."
+4
Improved CMS STAR Rating
3x
Focused efforts aligned with CMS success criteria
3 month
Reduced planning time through smart simulation of scenarios
Process
Conclusion
The Stars Decision Engine transformed how Medicare Advantage Plans approach CMS Star Ratings by replacing manual, reactive processes with AI-driven, predictive decision-making. Through a user-centered design approach, the solution empowered payers with actionable insights, streamlined workflows, and sustainable quality improvements, leading to faster gap closure and higher Star performance.