The Financial Case

Small moves in Stars drive outsized financial impact.

Star Ratings determine benchmark factor, rebate retention, quality bonus, and competitive positioning simultaneously. Understanding the financial mechanics is essential to evaluating any quality improvement investment.

RatingBenchmark FactorRebate RetainedQuality Bonus
3.0 or below1.00050%No
3.51.00065%No
4.01.05065%Yes
4.5+1.05070%Yes

The 3.0 to 3.5 move is the most underappreciated move in Medicare Advantage. No bonus at either level, but rebate retention jumps from 50% to 65%. On a moderately-sized contract, that single half-star can mean millions in retained revenue.

On a 100,000-member contract, the 3-to-4 star move can generate tens of millions in benchmark revenue before enrollment growth effects.

And the margins are razor-thin. A plan rated 3.750000 rounds up to 4.0 stars. A plan rated 3.749999 rounds down to 3.5. One gap, on one measure, on one member can be the difference. One plan missed 4 stars by 0.0001 and it cost $16 million.

The Measurement Timeline

Gaps closed today take three years to reach your bottom line.

2026
Gaps closed
Measurement year
2027
Data measured
and reported
2028
Star Rating
published
2029
Payment year
applied

Every month you wait is measurement data you can't get back.

We don't need to be in your bid. This is quality improvement, not benefit enrichment. We can start closing gaps the month you give us your member list.

Physician consulting with patient during community encounter

Two revenue streams from a single clinical investment.

Measures We Impact

The measures that move your rating, closed at the point of care.

Controlling Blood Pressure (CBP)

3x weight

Outcome measure. Blood pressure controlled at the point of care during the encounter. Not a referral. Not a reminder. Actual clinical management.

Hemoglobin A1C Control (HBD)

3x weight

Outcome measure. Point-of-care A1C testing during the encounter. Results documented and coded same-day.

Stars Improvement Measure

5x weight

Year-over-year change in measure performance. Rewards movement, not just position. The highest-weighted factor in the Stars formula.

Diabetic Eye Exam (EED)

Retinal imaging performed during the community encounter.

Breast Cancer Screening

Member outreach and scheduling during the encounter.

Colorectal Cancer Screening

Member outreach and scheduling during the encounter.

Risk Adjustment / HCC Capture

Every diagnosis documented during the encounter feeds risk scores. Accurately coded members generate $150–$230/month more in capitated revenue than under-coded members.

SDoH + SSBCI Eligibility

Validated screening instruments administered during the encounter. Individual-level social determinant data, not zip-code-level estimates.

Regulatory Environment

The regulatory landscape is moving toward encounter-based models.

1

Administrative measures leaving Stars.

What remains is clinically influenced. Providers become the only pathway.

2

In-home assessments under regulatory scrutiny.

Coding diagnoses without delivering care is the vulnerability CMS is targeting.

3

Unlinked chart reviews being curtailed.

Retrospective coding without an encounter is harder to defend.

4

Encounter-data-only risk adjustment on the table.

If it passes, only diagnoses from actual clinical encounters count.

Every Revella encounter delivers actual clinical care. The diagnosis capture happens because we're treating the member. If encounter-data-only risk adjustment passes, our model is built for it.

Get Started

Give us 500 members on one H-Number. We'll show you the Stars impact.

20-minute call. Pilot data, operational model, and financial case specific to your contract.

Book a Call to Learn More

Currently deployed with Medicare Advantage and ACA Marketplace plans across multiple states.