With Star Ratings Plummeting, New Report Uncovers the Health IT Strategies Used by Elite Plans-and How All Payers Are Leveraging Them to Drive Quality, Retention, and Regulatory Success

NEW YORK CITY, NY / ACCESS Newswire / June 1, 2025 / With Medicare Advantage (MA) Star Ratings hitting their lowest average in over a decade, pressure on health plans to perform under intensifying regulatory scrutiny has reached a critical point. In its latest report, "The 2025 MA Star Ratings Crisis: How Elite Plans Are Using Technology to Succeed Amid Stricter CMS Standards," Black Book Research reveals the digital strategies and platforms driving measurable results-not only in the Medicare Advantage space but increasingly across all payer types, including commercial insurers, Medicaid managed care organizations, and ACA marketplaces.

Only seven MA plans earned a 5-star rating in 2025, down dramatically from 38 in 2024, as CMS raised quality performance thresholds. The technologies adopted by these top-rated plans are now serving as blueprints for broader enterprise transformation across the payer landscape, helping organizations improve quality metrics, elevate member experience, and ensure operational compliance.

Independent Survey and Scope

This report draws from a comprehensive, independently conducted survey of nearly one thousandsenior IT and operations leaders representing five hundred Medicare Advantage and commercial health plans during Q1-Q2 2025. Over three hundred software vendors were evaluated using eighteen qualitative key performance indicators (KPIs), including: Operational efficiency; Member satisfaction and engagement; Scalability and interoperability; Regulatory compliance; as well as Impact on CMS-aligned metrics (HEDIS, CAHPS, grievance resolution, audit readiness). All findings are vendor-agnostic, independently verified, and free from paid participation or influence.

From Medicare to Market-Wide Transformation

Technologies originally designed to support Medicare Star Ratings are now redefining success across the entire health insurance industry:

Commercial plans are adopting CAHPS-modeled feedback loops and Stars-inspired frameworks to boost loyalty and retention.

Medicaid MCOs are integrating grievance tracking, SDoH engagement, and provider network optimization tools rooted in CMS standards.

Employer and ACA plans are leveraging analytics, engagement platforms, and gap-closure tools pioneered by leading MA plans.

"Star Ratings may have been designed for Medicare Advantage, but their influence is now systemic," said Doug Brown, Founder of Black Book Research. "The digital platforms powering top MA performance are now essential to delivering quality, experience, and efficiency across every payer segment. As regulatory expectations and consumer demands rise, all health plans, whether commercial, Medicaid, or employer-sponsored, have a strategic opportunity to accelerate digital transformation by partnering with proven vendors that consistently deliver measurable impact across the industry."

10 Critical Technology Clusters Driving Payer Success

High-performing plans consistently adopted and scaled solutions in the following key domains:

Care Coordination and Chronic Disease Management - Integrated tools improving transitions and reducing avoidable hospitalizations

Member Engagement and Experience Personalization - Omnichannel systems optimizing CAHPS-related satisfaction metrics

Preventive Services Utilization and Risk Adjustment - Platforms enhancing Stars and HEDIS outcomes

Predictive Analytics and AI-Driven Insights - Real-time data models driving targeted population health actions

Enterprise Quality Management and Compliance - Solutions aligning with CMS, NCQA, and URAC standards

Provider Network Optimization and Collaboration - Tools improving referral flow, directory accuracy, and contract performance

Grievance, Appeals, and Case Resolution - Automated workflows ensuring timely regulatory compliance

Retention and Loyalty Management - NPS-based tools and churn predictors strengthening member retention

Pharmacy and Interdisciplinary Care Integration - Medication safety and alert systems improving outcomes

Interoperability and Consent Management - FHIR-enabled APIs and secure data-sharing infrastructure

Top 20 Comprehensive MA and Managed Care Vendors

Survey respondents from 5-star MA plans and other high-performing organizations identified the following 20 vendors as having the most significant impact across these functional domains. Vendors are listed by functional area and were selected solely based on survey volume and performance context:

Inovalon - Industry-leading analytics and quality measurement tools supporting HEDIS and Star Rating improvements

Cotiviti - Predictive analytics and data integration for optimized preventive care and risk adjustment

Health Catalyst - Real-time insights through advanced data warehousing and AI-enabled dashboards

Arcadia - Robust population health management and seamless data aggregation

Innovaccer - Unified member records and interoperable care coordination

HealthEdge (GuidingCare) - Integrated care management and quality optimization platform

Medecision (Aerial) - Predictive workflows improving readmission rates and engagement

EXL (CareRadius) - Automation and analytics for managing high-risk populations

VirtualHealth (HELIO) - Unified care management enabling real-time clinical interventions

ZeOmega (Jiva) - Full-spectrum care management and interoperability boosting satisfaction and Star scores

Tabula Rasa HealthCare - Advanced pharmacy solutions reducing adverse drug events

Icario - Personalized engagement rooted in behavioral science to drive preventive care

mPulse Mobile - Conversational AI improving communication and CAHPS-related experiences

Bamboo Health (Collective Medical) - Real-time clinical event notifications improving transitions

HealthMine - Multi-channel outreach and analytics elevating preventive utilization

ReferWell - Referral management optimizing provider coordination

WellSky - SDoH and population health tools reducing preventable admissions

HealthCrowd - Behavioral engagement and screening adherence improvement

Convey Health Solutions - Automated grievance and appeals management for enhanced MA operations

Zipari - Consumer experience platform supporting engagement, retention, and Stars performance

Raising the Bar for All Payer Segments

Findings from the 2025 survey confirm a growing trend: the same technologies that drive MA excellence are now enhancing delivery, satisfaction, and outcomes across all health plan types. Notable applications include:

Commercial Insurance: CAHPS-modeled feedback loops and digital experience benchmarking

Medicaid: Stars-style performance tracking, SDoH engagement, and compliance analytics

Employer Plans: NPS tracking, retention modeling, and personalized engagement

All Payers: Unified data platforms and real-time insights through expanded interoperability investments

Access the Full Report

The full report, "The 2025 MA Star Ratings Crisis: How Elite Plans Are Using Technology to Succeed," including detailed KPI frameworks, vendor-functionality mapping, and survey methodology, is now available at:
https://blackbookmarketresearch.com/technology-enablers-for-high-performing-medicare-health-plans-2025

Media inquiries, payer-specific briefings, or customized presentations for Medicare, Medicaid, or Commercial audiences:
research@blackbookmarketresearch.com

SOURCE: Black Book Research