Prototype · Interactive Demo
AI-Native Healthcare
Quality Control
A closed-loop system demonstrating AI-driven care gap detection, policy evaluation, and intervention across HEDIS and Stars quality measures.
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Audit
Ready to run a one-click executive walkthrough.
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Audit
👤 Patient Panel
🛡 Policy Evaluation
⚡ AI Gap Detection
⚙ Action Engine
📈 Stars Impact Simulator
🎯 Patient Stars Lift Prioritizer
Analyze all synthetic patients and rank them by estimated Stars lift potential. The model scores each open care gap using measure weight, gap severity, closure probability, Star threshold proximity, and financial impact — then sorts descending from highest to lowest value.
📊 Understanding the Stars Financial Model
What these numbers mean
Revenue
Total annual plan revenue before any quality bonus — calculated as Members × PMPM × 12 months.
Bonus
Additional CMS quality bonus revenue unlocked by reaching 4+ Stars, paid as a percentage of base revenue.
Revenue Lift
Difference between the projected bonus at the target Star rating and the current bonus — the financial upside of quality improvement.
Measure Contribution
Estimated share of total revenue lift attributable to this measure, scaled by its relative weight in the Stars formula.
Current → Projected Stars
How closing care gaps for this measure may move the plan toward a stronger CMS rating and higher bonus tier.
"Closing care gaps converts clinical action into measurable revenue."
How the calculator works
Members
×
PMPM
×
12 mo.
→
Annual Revenue
×
Bonus %
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Bonus Revenue
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Revenue Lift
The model translates quality improvement into plan-level financial impact. Bonus percentage is determined by the plan's composite Star rating.
3.5 ★
0% bonus
4.0 ★
+5% bonus
4.5 ★
+10% bonus
5.0 ★
+15% bonus
Current vs Projected
Current State
Star Rating
3.5 ★
Annual Revenue
$720.00M
Bonus Revenue
$0
Projected State
Star Rating
4.0 ★
Bonus Revenue
$36.00M
Revenue Lift
+$36.00M
One measure, plan-wide impact
Care gaps closed
Patients in the measure denominator receive overdue screenings, labs, or therapy
Measure performance improves
Numerator rate rises as more eligible members meet the clinical threshold
Star threshold crossed
Aggregate weighted measure scores push the plan's composite rating above a bonus tier cutpoint
Plan-wide bonus opportunity unlocked
CMS applies the bonus percentage to the full plan risk-adjusted revenue base — not just members covered by the measure
Revenue lift realized
Projected bonus minus current bonus — the financial value of the quality improvement program
Key Insight
A measure may apply to a subset of members, but crossing a Star threshold can affect bonus economics across the broader plan.
💰 Stars Financial Impact
Plan Assumptions
Total Membersⓘ
Avg PMPM Revenue ($)ⓘ
Current Star Ratingⓘ
Projected Star Ratingⓘ
Measure Parameters
Gap Closure Rateⓘ
65%
Eligible Members (Measure)ⓘ
Current Measure Performanceⓘ
78%
Cut Point Neededⓘ
81%
Measure Weightⓘ
3.3%
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