4 days ago
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:
Media inquiries, payer-specific briefings, or customized presentations for Medicare, Medicaid, or Commercial audiences:
[email protected]
Contact InformationPress Office 8008637590
SOURCE: Black Book Research
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