Perficient Stars AI Navigator provides AI-driven insights that help health plans see Stars risk before ratings are finalized, so teams can act while the outcome is still theirs to optimize.
Stars performance is becoming more volatile, and static dashboards can’t keep up. By the time risk appears, the window to act is gone.
Health plans need a more predictive way to manage performance. One that surfaces measure-level risk earlier, guides targeted intervention, and adapts as CMS rules evolve. With the right intelligence in place, teams can improve member experience, strengthen quality of care, and protect the financial value tied to Stars.
Sources (left to right): Fierce Healthcare • PressGaney
Perficient Stars AI Navigator predicts risk, prioritizes action, and operationalizes improvement before ratings are finalized. It gives teams greater influence over the data, decisions, and interventions that shape Stars performance.
Built on a secure-by-design, zero-trust platform, it enables health plans to strengthen retention, improve member engagement, protect bonus payments, and drive more predictable Stars outcomes.
Model current and target Star Rating scenarios — and see what's at stake.
Contract type, enrollment, and an accurate benchmark drive the calculation.
* Required Inputs
Set the plan's current and target overall Star Rating to see the impact.
This calculator provides a hypothetical, directional estimate for illustrative and educational purposes only and does not constitute financial advice, a guarantee of results, or a projection of actual plan performance. Outputs are based on simplified assumptions and publicly available CMS data that may be outdated or incomplete. Actual payment impact will vary based on county-level benchmarks, plan bids, risk adjustment, contract structure, enrollment mix, CMS methodology, applicable payment year, regulatory changes, and other factors not modeled here. Users should consult qualified actuarial or financial advisors before making business decisions based on this information.
Perficient Stars AI Navigator is not another dashboard. It is an AI-native solution that helps health plans manage Stars performance with governed data, CMS-aligned calculations, predictive insights, and agent-driven engagement.
Unify, govern, map, and prepare Stars data across sources with a FHIR-native data foundation.
Apply audited, versioned measure logic through a calculation engine aligned to CMS requirements.
Forecast Stars performance and identify the drivers behind measure-level risk with predictive and prescriptive models.
Drive member engagement and improve adherence to support stronger Stars outcomes with cross-functional workflows.
Many Stars solutions require data to move outside your environment. Perficient Stars AI Navigator takes a different approach. Designed to integrate with the technology platforms you already trust, it helps keep your data, models, and calculations within your control. Built with HIPAA-aligned safeguards and support for audit readiness, it provides actionable intelligence while minimizing data movement and administrative burden.
Turn complex Stars data into clear, actionable intelligence that helps teams prioritize interventions, improve performance, and focus resources where they can have the greatest impact.
Monitor ratings, weighted measures, and financial impact in one view.
Identify underperforming contracts and prioritize interventions in real time.
Find members with open gaps and the personalized actions needed to close them.
Evaluate outreach from intervention to gap closure, including status, audience performance, and projected rating impact.
Run what-if scenarios to project ROI, model CMS rule changes, and guide budget decisions before dollars are committed.
Use natural language prompts to analyze performance, surface risks, and uncover next-step insights.
Medicare Advantage plans that treat Star Ratings as a compliance score are missing what Stars really controls: revenue, rebate funding, benefit design, and competitive position.
Healthcare organizations are adopting AI quickly, but without intentional design, the tools meant to improve care could reinforce the same access gaps they aim to solve.
Senior Vice President
Healthcare & Life Sciences Lead
Associate Vice President
Healthcare Strategy & Solutions
Director
Healthcare Strategy & Solutions
Perficient Stars AI Navigator is an AI-native Star Ratings performance management offering for Medicare Advantage and Prescription Drug organizations. It brings together FHIR-native data, predictive models, and AI-guided workflows to help plans identify risk, prioritize interventions, and act before ratings are finalized. Leaders can focus investments on the measures most likely to improve performance, strengthen CAHPS and member experience, and protect bonus revenue.
Traditional Stars reporting shows what has already happened. Stars AI Navigator helps health plans see what is likely to happen next. The solution forecasts ratings, identifies measure-level risk, simulates interventions, and uses agent-driven workflows to move insights into action. Instead of relying on broad campaigns or delayed third-party dashboards, quality teams can focus their resources where they are most likely to improve performance.
Stars performance is becoming harder to predict, yet many care teams still rely on reactive, backward-looking models. Measure changes, evolving CAHPS weighting, and increased performance volatility can put Quality Bonus Payments at risk before teams have time to respond. At the same time, many quality programs still depend on siloed processes, including outreach lists, vendor-managed initiatives, static dashboards, and manual workflows. Stars AI Navigator brings data, intelligence, and action together in one platform, helping health plans understand what’s driving performance, identify emerging risks, and focus on the interventions that can have the greatest impact.
Perficient Stars AI Navigator is designed to operate within the health plan’s technology environment, including platforms such as Databricks, Google Cloud, Snowflake, and AWS. Built on a secure-by-design, zero-trust platform, it keeps data, models, and calculations within the organization’s environment, to secure access to sensitive data.
You set your current and target Star ratings directly using two sliders (1.0–5.0 stars, in 0.5-Star steps). The calculator does not derive your rating from measure-level data. The target can't be set below your current rating, since the tool is built to showcase the value of closing a gap, not creating one.
Those two numbers are then checked against two known CMS thresholds: the 4.0-Star benchmark bonus cliff (0% vs. 5%) and the rebate percentage tiers: 50%, 65%, 70%. The dollar figure shown is the estimated difference in bonus and rebate dollars between your current and target rating, applied to your enrollment and benchmark.
Note: This calculator models the financial value of a rating gap; it doesn't predict what rating your plan will actually achieve from any given set of improvements. It is not inclusive of all possible influences of bonus and rebate dollars but is intended to provide a helpful understanding of the potential value available.