The Medicare Advantage Program continues to grow, serving over 50% of all Medicare beneficiaries. With this expansion comes a demand for higher performance in quality measures, risk accuracy, and cost control. By enhancing HCC Coding, bolstering Star Rating results, and incorporating real-time data straight into EHRs, solutions such as Persivia CareSpace® satisfy these requirements. Persivia is positioned as a pioneer in healthcare transformation due to these technologies, which enable payers and providers to reduce care gaps, personalize patient journeys, and better manage chronic illnesses.
The Medicare Advantage Program has changed how health plans deliver care. With over 50 million enrollees and rising, payers need to keep up with expectations for richer benefits, simpler access, and better care coordination. Members want integrated experiences, and CMS wants measurable outcomes.
Right at the core of that performance equation is HCC Coding, EHRs, and Star Rating, three interconnected things that can make or break success under Medicare Advantage. When used strategically, they fuel risk-adjusted reimbursement, compliance, and quality benchmarks with real, trackable value.
What’s Fueling the Shift to MA Plans?
Consumers are choosing Medicare Advantage for three core reasons:
- Expanded coverage with vision, dental, and wellness benefits.
- Predictable spending through capped out-of-pocket costs.
- Simplified access under one plan and provider network.
The market has also seen an uptick in Special Needs Plans (SNPs), now representing 28% of MA enrollments. These plans serve high-need patients and rely heavily on accurate risk scoring and timely interventions.
Data Gaps That Derail Performance
Disjointed systems remain one of the biggest challenges. Incomplete data leads to missed opportunities in HCC Coding, delays in closing care gaps, and underperformance on Star Rating measures. Without integrated analytics, care management becomes reactive, not proactive.
Note: More than 60% of care gaps originate from communication breakdowns between payers and providers.
Smarter, More Responsive EHRs
EHRs ought to be more than just electronic file cabinets. They should display the complete patient story, including behavioral, social, and clinical data, highlight clinical insights, and notify teams of risk factors.
This is made feasible by integrated technologies like Persivia, which immediately integrate real-time analytics into provider processes, opening the door to prompt interventions.
Why HCC Coding Deserves More Attention
Hierarchical Condition Category (HCC Coding) helps CMS understand how sick patients are and how much care they’re likely to need. Plans use this system to receive accurate risk-adjusted payments.
Inaccurate or outdated coding can:
- Undermine care planning
- Reduce RAF scores and reimbursement
- Trigger audit risk due to over-coding
Persivia’s platform helps teams monitor trends, flag opportunities, and ensure every valid code is captured. With NLP-supported 98% code extraction accuracy, Persivia cuts through documentation noise and delivers clarity.
Star Ratings: The New Financial Driver
CMS’s Star Rating system determines bonus payments and plan stability. Plans with 4 or more stars see higher rebate dollars and enrollment traction.
What moves the needle on ratings?
- Preventive care tracking
- Adherence to medications
- Member satisfaction and engagement
Persivia boosts performance with patient-specific care prompts, outreach tools, and a single view of clinical, quality, and risk data.
Point-of-Care Precision with CareTrak®
Real-time insight matters most when a provider is face-to-face with a patient. Persivia CareTrak® delivers timely HCC and HEDIS data, care plans, and medication adherence reports straight to the provider’s EHR.
That’s smarter delivery of smarter care.
Using Dashboards to Drive Action
With Persivia’s dashboard, plans can:
- Identify Risk Adjustment Factor (RAF) opportunities
- Compare provider coding behaviors
- Surface patient-level needs fast
Improving Outcomes with Targeted Outreach
HEDIS measures reward plans for how well they manage population health. That’s where real-time stratification and AI-driven communication become essential.
Here’s how Persivia elevates outreach:
- Smart AI outreach: Automated nudges and reminders
- Geographic & demographic stratification: Get granular
- Sneakers on the Ground™: On-the-ground community engagement
Plans using these strategies have seen up to 42% fewer hospitalizations and 18% lower overall costs.
Real Results from Real Plans
Persivia’s platform isn’t theory, it’s proven performance:
- 120% increase in captured HCC opportunities
- 0.81 average RAF lift
- 2.54x improvement in coding accuracy
These metrics reflect better revenue flow, more accurate risk management, and improved member care.
What Makes a Platform Work?
A Digital Health Platform connects the dots between departments, providers, and data. It makes risk, quality, care, and compliance a coordinated effort instead of isolated silos.
The result? Better decisions. Lower costs. Stronger care.
Takeaway
The Medicare Advantage Program isn’t just about growing enrollment; it’s about delivering measurable value. Plans that succeed are those that integrate their systems, optimize coding, personalize engagement, and meet CMS benchmarks in stride.
All of that becomes achievable with the right platform.
The Smart Way Forward
Persivia delivers the infrastructure, insights, and innovation to elevate your Medicare Advantage strategy. Whether your goals are higher Star Ratings, improved risk adjustment, or proactive outreach, Persivia helps you lead.
Discover the smarter way to manage care, risk, and outcomes!