Beyond Star Ratings: The Hidden ROI of MedOrion’s Technology
When health plans think about the return on investment (ROI) of improving CMS Star Ratings, financial bonuses come to mind. That’s the obvious, measurable impact.
But a deeper layer of value often gets overlooked, which we’d like to highlight today. The hidden ROI provides tools for health plans to engage members and allocate resources. MedOrion’s technology goes beyond ratings, delivering long-term value that keeps members healthier, boosts operational efficiency, and improves health plans’ strategic decision-making.
Member Retention: Keeping Members Happy & Healthy
Like customers in any field, satisfied members become loyal and stay with health plans longer. In this case, the key is making members feel seen and understood on a deeper level. MedOrion’s EBR technology and behavioral AI understand what motivates members and encourages them to make better health decisions based on the uncovered barriers standing in their way. The result? Improved satisfaction, better outcomes, and fewer reasons to switch plans. Our data shows that when members’ concerns are addressed in a personal, relevant, and supportive manner, complaint rates drop by 25%. Since public studies show that acquiring a new customer costs five to seven times more than retaining an existing one, the ROI is clearer than ever.
Health plans can significantly benefit from maintaining a healthier, more engaged member base that costs less to manage. MedOrion helps plans build solid, long-term relationships with members by proactively addressing gaps in care and offering personal and relevant interactions.
Better Resource Utilization: Making Wiser Investments
Knowing which operational decision will yield the most value is extremely powerful, and in some cases, MedOrion’s technology enables that. For example, decisions regarding where to open new clinics, enhance the current provider networks, or expand services can be made based on logistical barriers preventing members from making better health decisions.
We’ve discussed issues like distance-related medication adherence challenges and the impact such moves can have on Star Ratings, but the ROI of informed, cost-effective operations extends well beyond annual bonuses. MedOrion’s EBR technology and the data-driven insights it provides let health plans know where strategic investments generate the greatest impact. Our interactive mapping tool can list areas with a low number of specialists to uncover relevant logistical barriers.
Instead of guessing where additional providers or services might be needed, plans can use AI-powered analytics to understand regional demand, identify care gaps, and efficiently allocate resources.
Reducing Administrative Burden: Freeing Up Time for What Matters
Health plan teams have a lot on their plates, and managing member engagement and outreach campaigns can be a heavy administrative burden that often compromises results. MedOrion’s automated, AI-driven platform reduces the need for manual interventions, allowing teams to easily manage multiple quality improvement aspects and focus on higher-value activities. Our technology enables teams to simultaneously track multiple measures without needing to juggle multiple systems.
This approach improves efficiency and reduces operational costs, allowing teams to dedicate more time to meaningful member interactions that demand personal interventions. Reducing the administrative burden helps prevent employee burnout, boosts team motivation, enhances service quality, and cuts turnover costs.
One Holistic Platform: Addressing Operational Clutter
Many Quality Improvement teams work with multiple tools and vendors, a daily reality that can be overwhelming and inefficient. The problem of constantly switching between platforms is evident in every field, with employees stating they lose around five hours each week due to the need to navigate too many tools.
MedOrion’s holistic platform allows health plans to prevent inefficiencies caused by scattered systems. Consolidating multiple solutions eliminates the need to piece together insights from many disconnected tools, offering more clarity in less time.
The hidden ROI here is significant: fewer vendor negotiations, reduced infrastructure complexity, and a more unified view of member needs and operational performance. Health plans benefit from streamlined decision-making, quicker interventions, and increased agility, which are useful given the dynamic reality of changing member expectations or regulatory requirements.
CMS Star Ratings come with direct financial incentives, but the ROI of MedOrion’s technology is about so much more. Health plans that recognize these profound benefits position themselves for higher annual ratings and a stronger, more resilient future in a highly competitive field.