Achieving high Medicare Advantage (MA) Star ratings has never been more complex—or more data-dependent. Health plans are under constant pressure to adapt to evolving regulatory requirements, improve member outcomes, and optimize financial performance. At the heart of all these efforts is one critical factor: data quality.
High-performing plans have one thing in common: they operate with data that is reliable, fresh, and complete. In contrast, many organizations struggle with fragmented data systems, outdated reports, and manual reconciliation processes that slow down decision-making. The difference between a data-driven plan and one that is constantly playing catch-up can have a major impact on Star ratings and overall success.
What Defines “Good” Data?
Not all data is created equal. In order to drive performance, good data must meet three essential criteria:
- Reliability – Data should be available when it is needed, without inconsistencies or delays. Business and clinical teams should not have to second-guess whether they can trust the information they’re working with.
- Timeliness – Using stale reports that reflect three-month-old realities makes it difficult to intervene effectively. High-performing plans ensure their data is as real-time as possible.
- Completeness and Accuracy – Partial or inaccurate data leads to flawed insights. Plans that validate and reconcile their data continuously are better positioned to take meaningful action.
Many health plans operate in environments where data silos and inconsistencies are the norm. IT and business teams spend valuable time trying to clean, merge, and interpret data rather than using it to drive better outcomes. This is why leading plans invest in centralized, well-governed data platforms that serve as a single source of truth for the organization.
Steps to Overcome Data Challenges
Transforming a fragmented data environment into a high-performing one does not have to be overwhelming. The key is to start with focused, achievable initiatives that show measurable impact. Here are three practical steps to take:
- Start Small, Prove Value Quickly Instead of trying to overhaul the entire data system at once, successful plans focus on a specific Star measure or a subset of the program. By demonstrating clear ROI within a single budget cycle, it becomes easier to justify further investment in data improvements.
- Automate Data Validation and Reconciliation Health plans often struggle with misaligned data between their internal systems and CMS. Gaps in member adherence, incomplete PDE submissions, and inaccurate exclusions can all impact Star performance. Automating these processes ensures that plans are working with the most accurate and actionable data at all times.
- Leverage Technology to Handle Complexity With the volume of data exploding across healthcare overall and even more so in health plan operations, the sheer breadth and complexity of information that health plans manage is staggering. Instead of relying on outdated processes, high-performing plans use advanced analytics platforms to:
- Monitor Star measure performance in real time
- Reconcile plan data with CMS data automatically
- Generate actionable provider and member-level reports
Why Investing in Data Quality Pays Off
The Star rating system is becoming increasingly dynamic and data-driven. Measure weights, scoring methodologies, and compliance rules shift regularly, making it even more important to have a robust, adaptable data infrastructure.
By investing in data reliability, timeliness, and accuracy, health plans can:
- Improve Star ratings with better adherence tracking and timely interventions
- Enhance compliance by aligning plan data with regulatory requirements
- Increase operational efficiency by reducing manual reconciliation work
- Drive better member outcomes with more precise, data-informed decisions
Plans that take a proactive approach to data management are better positioned to succeed in an increasingly competitive landscape. The future of Star performance isn’t just about the right strategies—it’s about having the right data to execute them effectively.
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If you want to explore how Lilac can help your plan get more out of data, check out our Star Solution page or start a conversation by reaching out to us via the form in this link.
