Model your Medicare Advantage plan's quality performance across all CMS domains. Input your measure rates, see your projected overall Star Rating, and identify the highest-impact improvement opportunities.
Enter your plan's current performance rates across clinical quality, member experience, and operational measures. Use presets to quickly load benchmark scenarios.
The simulator calculates your projected overall Star Rating, domain-level scores, and quality bonus eligibility in real time as you adjust measure values.
Identify which measures deliver the most star-rating lift per point of improvement, weighted by CMS measure weights and distance to the next threshold.
Understanding the methodology helps you make strategic decisions about where to invest your quality improvement resources.
CMS assigns different weights based on measure type. For 2026, outcome and intermediate outcome measures carry 3× weight, patient experience and access measures carry 2× weight, and process measures carry 1× weight. Higher-weighted measures have more influence on your overall rating.
Star thresholds are determined each year using a hierarchical clustering algorithm applied to all contract scores. The algorithm finds natural "gaps" in performance and creates four cut points that divide plans into five rating levels. Cut points shift annually based on industry-wide performance.
Plans achieving 4.0 or more overall stars receive a 5% quality bonus payment (QBP) on their CMS benchmark. For a plan with 50,000 members at $1,100 PMPM, that's $33M in additional annual revenue. Five-star plans receive additional rebate percentage increases.
Our team builds custom Star Rating models with your actual contract data, measure-level trending, and targeted intervention strategies to help you reach your quality goals.
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