Your population health analytics are sophisticated. The gap between identifying a member who needs outreach and completing that outreach — at full-member-population scale, across the measures that move your Star Rating — is where revenue is won or lost.
Request a DemoMedicare Advantage plans compete on Star Ratings and risk adjustment accuracy. Both depend on member engagement, clinical documentation, and care coordination that most plans cannot execute at full-member-population scale. The analytics to identify the gap are sophisticated. The workflow execution layer to close it is the missing piece.
HEDIS measures that move Stars — medication adherence, diabetes care, blood pressure control, colorectal screening — require member contact, appointment scheduling, and clinical follow-through that plan-level care management cannot execute at full-population scale.
Members with chronic conditions present but underdocumented suppress risk adjustment revenue. Closing documentation gaps requires outreach, visit completion, and documentation alignment that internal teams can’t sustain across the full member population.
The members who drive the highest total cost of care are often the hardest to engage proactively. Reaching them before a hospitalization or ED visit requires outreach capacity that case manager caseloads cannot sustain across the full high-risk cohort.
PDC scores for diabetes, hypertension, and cholesterol medications directly affect Star Ratings. Moving PDC scores requires consistent member contact and barrier resolution — cost, pharmacy access, side effects — not just fill reminders that generate no-responses.
Zynix AI is the member outreach and care coordination execution layer between your population health intelligence and your member population. It handles the contact volume, barrier resolution, and documentation workflows that your Stars and risk adjustment programs require but cannot execute manually at scale.
Quality gap reminders, HCC documentation outreach, medication adherence check-ins, and preventive care follow-through executed for every eligible member, not just those a case manager had time to call. Contact rates move when the outreach reaches the full cohort.
Two-way conversations identify cost, access, transportation, and language barriers in the same interaction where the clinical need is surfaced — and route each barrier to resolution without requiring a second follow-up.
HCC gaps prioritized by revenue impact. Outreach, scheduling, visit completion, and documentation coordinated in sequence. The risk adjustment deadline is a fixed constraint — the execution layer runs to meet it.
ZynPredict surfaces members on a deterioration trajectory before a hospitalization or ED visit. Proactive outreach engages them at the right window — identifying the barriers driving the risk and connecting to chronic care management.
Use Cases
Star Ratings are earned member by member. How quality measure completion moves at full-member-population scale, not just for the members a case manager reached.
View use case →Underdocumented conditions suppress risk adjustment revenue. Closing documentation gaps at member-population scale requires more than a case manager workflow can deliver.
View use case →The members who drive the most cost are the hardest to reach proactively. Structured, risk-tiered outreach before the clinical event, before the claim arrives.
View use case →High-risk MA members discharged from hospital face compounded readmission risk. The 48-hour window is where the outcome is determined.
View use case →Moving PDC scores requires barrier resolution, not fill reminders. The two-way outreach workflow that identifies and routes the real obstacles to medication adherence.
View use case →Platform
HCC and quality gap identification across your member population, prioritized by risk adjustment impact and Stars measure completion timing. Actionable worklists, not raw gap exports.
Rising risk member outreach, readmission risk monitoring, high-utilizer ED diversion. Acts on ZynPredict signals before the clinical event, not after the claim arrives.
Medication adherence outreach, Transitions of Care Agent, Preventive and Quality Activation. The member engagement execution layer for Medicare Advantage population scale.
Orchestrated program that coordinates outreach, visit completion, and documentation for the highest-impact HCC and quality gaps before the risk adjustment deadline.
Medication adherence, care coordination, and chronic disease management measures carry the highest weight in overall Star Rating calculation for Medicare Advantage plans.
Plans that move these measures by even a fraction of a star generate significant revenue implications — the bonus structure amplifies the value of incremental improvement.
HCC documentation gaps are most common in members with multiple chronic conditions who have limited care team contact — the cohort where risk adjustment revenue opportunity is highest.
Closing documentation gaps requires proactive outreach and visit completion — administrative coding review alone cannot close gaps that require a clinical encounter.
Plans with higher member outreach completion rates consistently show stronger Stars performance on quality and outcome measures than plans with lower contact rates.
Contact rate is the leading indicator — the relationship is about whether the member was reached at all, not the sophistication of the outreach program.
NAACOS Research on Care Management Outcomes
After-hours access and post-discharge follow-up rates are significant predictors of avoidable hospitalization and ED utilization in Medicare Advantage populations.
For MA plans, avoidable hospitalizations affect both Stars measures and total cost of care — the financial and quality incentives align on the same workflow gap.
Published Medicare Advantage outcomes research
Use Cases
Star Ratings are earned member by member. How quality measure completion moves at full-member-population scale, not just for the members a case manager reached.
View use case →Underdocumented conditions suppress risk adjustment revenue. Closing documentation gaps at member-population scale requires more than a case manager workflow can deliver.
View use case →The members who drive the most cost are the hardest to reach proactively. Structured, risk-tiered outreach before the clinical event, before the claim arrives.
View use case →High-risk MA members discharged from hospital face compounded readmission risk. The 48-hour window is where the outcome is determined.
View use case →Moving PDC scores requires barrier resolution, not fill reminders. The two-way outreach workflow that identifies and routes the real obstacles to medication adherence.
View use case →