A new standard for quality in healthcare.
Regulators publish how health plans, hospitals and manufacturers perform. QPROi™ traces each published score back to the operating capabilities that produce it, then ranks what to fix first, for whom, and what it is worth.
One fix, three measures, one rating step. See the full trace for more measures, capabilities and industries.
Swipe sideways to follow the full trace.
It starts with Medicare Advantage
See the operation behind the Star Rating.
For health plans, QPROi™ reads public CMS Star Ratings back to the operating capabilities a plan runs, ranks what to fix for members first, and finds the least-effort path to the next threshold. It starts before a single file is shared.
The health plan capability map
Nine domains covering every function a plan runs. Phase 0 reads what public data can reach; Phase 1 covers the rest with the plan's own data. The named capability map is shown in the demo.
Nine domains covering every function a plan runs. QPROi™ covers all of them across two phases. Select a domain to see its coverage. The named capability map is shown in the demo.
Why QPROi™
Leaders know their scores. The hard part is knowing which part of the operation to fix.
A Star Rating names the measure. It does not name the team, the process or the vendor behind it, or which fix helps members soonest. Analytics platforms need the plan's data before they can answer. Advisory work starts with weeks of interviews. QPROi™ starts with a defensible diagnosis from what CMS already publishes, then helps the plan act on it.
An outside-in diagnosis
A first read of the operation before any data-sharing agreement, IT project or interview schedule.
Experienced operators who help fix it
Every engagement is led by healthcare operating leaders. The technology does the analysis; people do the work with your teams.
Works with what you have
QPROi™ works alongside your analytics platform, quality vendors and advisors. It tells them where to focus.
What a plan receives
A full Phase 0 diagnostic in two to three weeks
Delivered with a working session for the leadership team, through a private client portal with PDFs and executive briefs for the board and C-suite. Every figure is checked against its source before release.
For Medicare Advantage plans: work done in 2027 counts in the 2027 measurement year, shows in the 2029 Star Ratings released in October 2028, and pays from January 2030.
- Executive Report
- Star position, cross-domain findings and ranked priorities in one place.
- Domain Diagnostics
- Capability-by-capability findings for Stars, Medical Management, Core Operations, and Provider and Vendor Governance.
- Master Diagnostic
- Every capability across every domain, with its measures, trend and status.
- Stars Simulation
- Value at each threshold and the least-effort paths to cross it.
- Stars Roadmap
- A phased remediation plan tied to the findings.
- Executive briefs
- Two-to-three-page briefs for each domain and a synthesis for the C-suite.
| Overall rating | Bonus and rebate per year | Step |
|---|---|---|
| 3.0★ | $30.5M | |
| 3.5★ today | $39.7M | +$9.2M |
| 4.0★ next | $48.7M | +$9.0M |
| 4.5★ | $52.4M | +$3.7M |
Slipping to 3.0★ would cost $9.2M a year; reaching 4.0★ adds $9.0M. The same work protects one and earns the other.
- Medication adherence3 triple-weighted measures at 2★; one shared cause
- Blood pressure control2★ for three years running
- Follow-up after dischargeReadmissions and ED follow-up, 2 measures
Each focus area names the teams that share it and the questions Phase 1 will answer.
- End of JanuaryAdherence tracking by drug class; uncontrolled members listed by provider
- End of Q1Pharmacist outreach live; chart review for blood pressure complete
- JuneMid-year rates against the 4★ cut points; course correction
Owners and in-year measures are set with the plan's teams.
Sample for illustration, not a specific plan's results. Dollar figures apply CMS payment rules to the median benchmark, bid and risk score of 2027 MA-PD contracts rated 3.5★.
Across the 306 MA-PD contracts below 4★ with payment data, the median gain from reaching 4★ is about $11M a year. With no improvement and 2027 cut points held, QPROi projects that 100 of the 164 contracts rated 3.5★ in 2027 fall below 3.5★ in 2029 as CMS removes measures and restores adherence weights.
How we work
Built to be checked
Public data first
The first diagnosis needs no data-sharing agreement and no IT project.
Real data only
QPROi™ uses published CMS data and, later, the client's own. No synthetic data.
Every figure verified
A numeric gate checks each number against its source before anything is released.
Clear about limits
Public-data findings are labeled as inferences until the plan's own data confirms them.
QPROi™ is led by healthcare operations and quality leaders with experience inside national health plans and health plan operations providers, working with advisory and clinical partners. Its rating engine reproduces 507 of 508 published 2027 MA-PD ratings.
Engagements
Start with a snapshot. Grow into a program.
Each stage is a service engagement led by experienced operators, with QPROi™ doing the analysis underneath. Each one scopes the next.
Stars Snapshot
One page, in days
Your Star position, the value at stake and the top three priorities.
Phase 0 Diagnostic
Two to three weeks
The full public-data diagnostic set, delivered through the client portal.
Phase 1 Validation
Eight to twelve weeks
Your data confirms the findings across all nine domains.
Activation
One priority domain at a time
Remediation with KPI tracking against benchmarks.
Portfolio
Annual
Every contract, refreshed each Star Ratings release.
Partners
Built to work alongside the people who deliver quality
Healthcare consulting and advisory
Healthcare consulting and advisory for health plans and health systems. Naya and QPROi™ work together on joint engagements, from diagnosis through delivery.
Clinical intelligence partner
Patient-level clinical intelligence that finds unattended care needs. Paired with QPROi™, it connects plan and health system quality findings to the patients behind them.
Channel and delivery partners
Consultancies and quality vendors
Stars consultancies, quality vendors and actuarial firms can use QPROi™ as the front end to their own engagements, with a consistent method across clients.
Questions
What leaders ask first
Do you need our data to start?
No. The Stars Snapshot and the Phase 0 diagnostic use only what CMS publishes. We do not ask for member data or any protected health information. Phase 1 uses your own data, under an agreement with your plan.
How accurate is it?
The rating engine applies CMS's published method and reproduces 507 of 508 published 2027 MA-PD ratings. Findings about your operation are labeled as inferences until your own data confirms them.
What does Phase 0 not tell us?
It is not an assessment of your people or systems. In Phase 0 each capability carries a Measure Signal, the average star rating of its linked measures, which shows where to look. Phase 1 rates maturity from 1 to 5 across people & organization, process & policy, and technology & data.
How long does it take?
A Stars Snapshot takes 3 to 5 days. The Phase 0 diagnostic takes 2 to 3 weeks. Phase 1 validation takes 8 to 12 weeks.
Is QPROi™ only for Medicare Advantage?
Health plans come first. Hospitals and health systems are in development, and other publicly scored, regulated industries are on the roadmap.
For Chief Quality Officers and Stars leaders at health plans
See where your plan stands
Request a one-page Stars Snapshot for your contract: your position, the value at stake and the top three priorities. You can also view a full diagnostic on a sample plan. The demo runs QPROi™ on a de-identified Medicare Advantage plan, built entirely from real public CMS data.
- Stars Snapshot for your contract, free
- Demo: Executive Report summary, Stars Simulation and a sample Domain Diagnostic
- A call with our team to walk through your results
- A market summary of the latest Star Ratings release: what moved and why, with no plans named
- A sample Phase 0 Executive Summary on a de-identified plan
Look up a contract
See any Medicare Advantage contract's published 2027 and 2026 Star Ratings. The Snapshot adds how far it sits from the next star level and what that step is worth.