Health Plans
Your Star Rating Window Is Closing
Every measurement year, health plans leave quality bonus revenue on the table, not from lack of strategy, but from the gap between identifying members who need care and actually getting them there.
The Stakes Are Higher Than Ever
- CMS cut bonus thresholds again — a half-star difference now means millions in Quality Bonus Program revenue at risk.
- HEDIS measurement windows don’t wait. Member outreach that doesn’t convert to completed appointments is money spent with nothing to show.
- Members who can’t get to care don’t stay on your plan. High-cost avoidable events erode your MLR and your margins.
- Competitors with better member engagement are already gaining ground on Star Ratings. Plans that don’t close that gap won’t get a second chance at the measurement year.
Health Plans
Your Star Rating Window Is Closing
Every measurement year, health plans leave quality bonus revenue on the table, not from lack of strategy, but from the gap between identifying members who need care and actually getting them there.
Health Plans
Your Star Rating Window Is Closing
Every measurement year, health plans leave quality bonus revenue on the table, not from lack of strategy, but from the gap between identifying members who need care and actually getting them there.
CMS Cut Bonus Thresholds Again
A half-star difference now means millions in Quality Bonus Program revenue at risk.
HEDIS Measurement Windows Don’t Wait
Member outreach that doesn’t convert to completed appointments is money spent with nothing to show.
Members Who Can’t Get to Care Don’t Stay on Your Plan
High-cost avoidable events erode your MLR and your margins.
Competitors are Gaining Ground on Star Ratings
Plans that don’t close gaps won’t get a second chance at the measurement year.
ReferWell Gets Your Members to the Doctor.
Most care management programs are built to identify who needs care. ReferWell is built for what comes next, the hard part. Scheduling. Showing up. Following through.
We combine ReferWell Connect™, our intelligent scheduling platform, with ReferWell Engage™, a team of expert Care Navigators who work on your behalf to reach members, remove barriers, and convert outreach into completed appointments at scale. We speak in your health plan’s voice, in the member’s native language, and we close the loop.
This is the missing middle, the human-led, tech-enabled layer your quality program has been missing.
Our programs can qualify as Medical Loss Ratio (MLR) spend, not administrative cost, which changes the budget conversation entirely.
What Health Plans See With ReferWell
8-10X
Validated ROI
~92%
Show Rate
Medicare Advantage (vs. 35-60% Industry)
3X
Higher Gap Closure
vs. Standard Outreach
88%
Member Retention Rate
For At-risk Members
How It Works
Your analytics engine identifies members with open quality gaps or overdue preventive needs.
ReferWell’s Care Navigators reach those members through personalized, persistent outreach — by phone, text, and email — in the member’s native language.
Our platform matches members to in-network, available providers and books the appointment on the spot.
We monitor for no-show risk, send reminders, and re-engage members who fall through the cracks.
You get closed-loop reporting tied to HEDIS, Risk Adjustment and Star Ratings performance. Your team will always knows where gaps stand.
The measurement year won’t pause while you evaluate options.
Plans that act now give themselves the runway to close gaps before it’s too late.