Healthmine Clients Excel in 2025 Star Ratings

Barchart · 10/15 12:33

Healthmine, a leader in technology-enabled engagement solutions, announced that its clients maintained positive scores in the Star Ratings, a substantial win in a tough scoring year. For Stars Year (SY) 2025, 70% of Healthmine’s on-platform clients maintained or improved their overall Star Ratings compared to SY2024, with 40% of them at or above 4 Stars.

Healthmine clients saw substantive improvement across several measures, including a 20% increase in flu shot completion. Other notable improvements include a 16% increase in breast cancer screenings, 15% increase in diabetic retinal eye exams and 15% increase in fall risk assessments. The company now partners with two 5-Star plans.

In recent years, Healthmine has invested in both platform development and subject matter expertise to give Medicare plans a more impactful path forward. This year, more plans saw a decrease in Stars than an increase, bringing Stars averages down to pre-pandemic levels.

Health plans have anticipated this moment after COVID-19 granted leniency in Stars scores. Pandemic flexibility is gone, and healthcare utilization is up, all while CMS continues to evolve Stars criteria.

“It is a tumultuous time in Medicare,” says Paul Mango, former Health and Human Services Deputy Chief of Staff for Policy, and Chairman of Healthmine’s Board of Directors. “Payers need to think hard about how they’re approaching quality, risk adjustment and health equity. Strategies that worked previously will be insufficient prospectively. It is time for new approaches.”

Nearly 70% of cut points increased from the 2024 Star Ratings. CMS is phasing in the new Tukey guardrails for determining cut points so health plans should expect additional cut point increases for measurement year 2025. The change from the Reward Factor to the Health Equity Index also means fewer plans will qualify for quality bonus payments and those that do will need to demonstrate success in eliminating health disparities at the measure level.

Healthmine developed Quality Relationship Management™ (QRM®) to give plans a 360-degree view of every member and overall performance. The integrated platform unifies member data from multiple sources and scales personalized, omnichannel engagement, allowing plans to reach the right members with the right message and at the right time, while keeping a near real time pulse on how it impacts gap closure and risk adjustment.

“We built QRM for health plans participating, and looking to thrive, in government programs,” says Bryce Williams, President and CEO of Healthmine. “QRM enables plans to scale up quickly where most needed and scale down in areas of lesser impact. Point solutions no longer deliver the flexibility plans require to focus on so many measures. Prioritizing one measure set won’t give plans the lift it once did. Plans now need to focus on social needs and health outcomes with the same vigor they do on member sentiment.”

About Healthmine

Healthmine is the industry’s leading member engagement solution, simplifying how health plans make the most of every member moment. Our SaaS-based, always-on Quality Relationship Management™ (QRM®) platform eliminates data chasing so plans can capture whole views of each member. Our team of behavioral scientists and regulatory experts partner with each health plan to use this member-level detail to build personalized outreach that motivates members to take the right next step in their health journeys. With customized triggers based on clinical, pharmacy, CAHPS and HOS measures, and when paired with intelligent incentives, plans can see accelerated results in health equity and member outcomes while better managing medical spend and reducing the burden on their teams. Real-time data dashboards with actionable insights allow plans to act fast and better prioritize areas of opportunity to meet revenue and quality goals. Connect with us at Healthmine.com and on LinkedIn.