Data-Driven Quality Improvement: Improving Provider Performance in Medicare Advantage

Sravanthi Kalapati ()

Journal of Technology and Systems, 2025, vol. 7, issue 3, 23 - 29

Abstract: In the evolving landscape of Medicare Advantage (MA), quality performance is not only a regulatory requirement but a strategic imperative. This paper explores how data engineering and advanced analytics are transforming provider performance through data-driven quality improvement initiatives. By integrating claims, EHR, patient-reported outcomes, and social determinants of health, organizations can generate a holistic view of care delivery. Predictive modeling, provider scorecards, and incentive-aligned financial models enable proactive interventions and measurable improvements in CMS Star Ratings and financial outcomes. The paper also addresses operational challenges such as data silos and provider buy-in, emphasizing the role of cloud platforms, collaborative ecosystems, and robust data governance. Looking forward, technologies like AI, NLP, and blockchain promise to elevate the impact of analytics in value-based care. This study provides a comprehensive, data engineer–oriented perspective on optimizing MA offerings through scalable, real-time, and compliant analytics strategies that support long-term sustainability and patient-centered outcomes

Keywords: Medicare Advantage; Data engineering; Quality improvement; Predictive analytics; Value-based care (search for similar items in EconPapers)
Date: 2025
References: Add references at CitEc
Citations:

Downloads: (external link)
https://carijournals.org/journals/article/view/2692/3103 (application/pdf)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:bhx:ojtjts:v:7:y:2025:i:3:p:23-29:id:2692

Access Statistics for this article

More articles in Journal of Technology and Systems from CARI Journals Limited
Bibliographic data for series maintained by Chief Editor ().