Black Book Research Reveals the Digital Playbook Behind 2025's Top Medicare Advantage and Commercial Health Plans
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:
[email protected]
Contact InformationPress Office 8008637590
SOURCE: Black Book Research
press release
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Fox News
19 minutes ago
- Fox News
Fox News beats ABC, NBC, CBS during weekday primetime while CNN has lowest-rated week of year
Fox News Channel beat all broadcast networks in a key metric last week as CNN had its lowest-rated week of the year. Fox News averaged 2.7 million viewers during primetime on weekdays from May 26-30, compared to 2.4 million for NBC, 2.4 million for CBS and 2.3 million for ABC. While Fox News prevailed against the trio of broadcast networks, it also obliterated CNN. Fox News averaged 1.5 million total day viewers from May 26 through June 1, compared to a dismal 308,000 for CNN. During primetime, Fox News averaged 2.3 million viewers while CNN settled for only 374,000. It was much of the same among the advertiser-coveted demographic of adults aged 25-54, as Fox News delivered 175,000 total day demo viewers and 240,000 during primetime, compared to 49,000 total day and 61,000 primetime demo viewers for CNN. CNN finished with its worst week of the year across both primetime and total day as Fox News had its highest cable news share since inauguration week. Along the way, the top 100 cable news telecasts for the week all aired on Fox News. "The Five" averaged 3.7 million total viewers and 409,000 in the critical demo to lead cable news in both categories. "Special Report with Bret Baier," "The Ingraham Angle," "Jesse Watters Primetime," "Hannity," "FOX News @ Night," "Gutfeld!," "Outnumbered," "The Will Cain Show," "America's Newsroom," "America Reports" and Harris Faulkner's "The Faulkner Focus" all had strong weeks, too, to help Fox News crush CNN. Ratings data courtesy of Nielsen Media Research.
CBS News
20 minutes ago
- CBS News
Allina Health doctors, PAs hold first-ever union picket, ask for better work-life balance in new contract
Six hundred Allina doctors, physician assistants and nurse practitioners who work in primary care are asking for a new contract with more work-life balance. They gathered in the pouring rain Tuesday morning for a first-of-its-kind protest. "We are here together as a result of many years of fighting, fighting for primary care and fighting to make things better," workers chanted. While nurses have walked the picket line for years, these picketers are doctors, PA's and nurse practitioners who are admittedly higher compensated. "We all get paid really well, its not about that. It's about having better support for our patients and support in our community and that we want a fair treatment in our contract and protections for everybody," said Dr. Chris Filetti, a pediatrician with Allina Health. WCCO The workers are asking for paid sick leave, instead of having to use vacation time. They're also asking for four hours a week to finish paperwork, instead of doing it in their off time. Additionally, they're asking for more medical assistants and nurses for support. "As a provider I hear story after story about providers who have to cut back from practice because of poor work-life balance," said Filetti. Allina's leaders say they are listening despite the unsettled contract, telling WCCO in a statement: "We continue to negotiate in good faith to reach responsible agreements that maintain competitive pay and benefits for our providers while ensuring that we can sustain our caring mission during these extremely uncertain economic times. It is important to get it right. We remain committed to reaching fair agreements that ensure we can maintain access to the high-quality care people depend on."
Wall Street Journal
20 minutes ago
- Wall Street Journal
Ukraine's Drone Strike Is a Warning—for the U.S.
By now Americans know about Ukraine's remarkable drone strike on Sunday that damaged as many as 40 aircraft deep inside Russia as strategic bombers sat like ducks in a row on military bases. One urgent lesson beyond that conflict is that the U.S. homeland is far more vulnerable than most Americans realize. The details about Ukraine's daring operation are few, but Kyiv managed to sneak cheap drones across the border and use them to destroy costly Russian military assets. The bang for Ukraine's buck was considerable. You don't have to be a fan of thrillers to imagine a similar scenario in the United States.
