IDEAS home Printed from https://ideas.repec.org/a/bhx/ojtjts/v7y2025i3p23-29id2692.html
   My bibliography  Save this article

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: https://carijournals.org/journals/article/view/2692/3103
    Download Restriction: no
    ---><---

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:bhx:ojtjts:v:7:y:2025:i:3:p:23-29:id:2692. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no bibliographic references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Chief Editor (email available below). General contact details of provider: https://www.carijournals.org/journals/index.php/JTS/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.