Case Study: Medicare Advantage Health Plan improves RAF scores and Star Ratings with Zymr's population health analytics

Medicare Advantage Health Plan boosts RAF scores 12% with Zymr

The customer, a Medicare Advantage health plan, faced challenges with fragmented data across over 185 systems, which hindered its ability to proactively manage member risk and improve accuracy for upcoming V28 RAF changes. To strengthen risk adjustment and quality scores, the health plan partnered with vendor Zymr to build a modern population health analytics platform.

Zymr designed and implemented a cloud-native analytics platform that consolidated data sources and used ML for risk stratification. This solution enabled earlier identification of high-risk members and coding gaps, improved provider engagement, and delivered real-time performance dashboards. As a result, Zymr helped the plan achieve a 12% improvement in RAF scores and increase its Star Ratings from 3.7 to 4.3.