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

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  • Sravanthi Kalapati

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

Suggested Citation

  • Sravanthi Kalapati, 2025. "Data-Driven Quality Improvement: Improving Provider Performance in Medicare Advantage," Journal of Technology and Systems, CARI Journals Limited, vol. 7(3), pages 23-29.
    • Handle: RePEc:bhx:ojtjts:v:7:y:2025:i:3:p:23-29:id:2692
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    File URL: https://carijournals.org/journals/article/view/2692/3103
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