Get ready for 2027: Stars, Risk Adjustment, and the teams behind them
Medicare Advantage Stars & Risk Adjustment
For a Medicare Advantage plan, a half-star can be the difference between investing in members and cutting back. Risk Adjustment is under more scrutiny than ever. And the 2027 changes leave regional plans little room to learn as they go.
I've led this work from the inside. At Providence Health Plan, I oversaw Stars, HEDIS, Quality, Risk Adjustment, and Healthcare Experience. We turned a 3.5-star CMS rating into 4.0 in 12 months and mitigated more than $80M at risk. We also reset a failing Risk Adjustment program, which mitigated $84M. I bring that same operator's view to your plan.
The 2027 readiness review
A focused, fixed-scope assessment that gives your leadership team a clear picture and a prioritized plan.
What we look at:
• Stars performance and trajectory. Where your measures stand, where you're exposed, and which levers move fastest.
• Member experience. CAHPS drivers, service operations, and the member journey points that cause friction.
• Risk Adjustment program health. Coding accuracy and RAF integrity, vendor performance, provider engagement, and audit readiness.
• Provider partnership. Whether your provider relationships are set up for joint problem-solving or stuck in blame.
• Data and governance. Whether leaders can see the right data in time to act, and who owns it.
• Leadership and operating rhythm. Prioritization, accountability, and the cadence that keeps improvement work on track.
What you receive:
• An executive readout for your CEO and senior team (board-ready if needed)
• A prioritized 90-day and 12-month action plan
• A risk heat map for Stars and Risk Adjustment
• Clear owners, measures, and quick wins
How it works: Kickoff, document and data review, leadership and frontline interviews, findings workshop, and final readout. The timeline is scoped to your plan's size, typically several weeks.
Fractional & interim executive advisory
Sometimes you need more than a plan. You need someone experienced in the seat. I serve as a fractional or interim leader for Quality & Stars, Risk Adjustment, or Healthcare Experience. That can mean steadying a team through a leadership transition, standing up a turnaround, or coaching your permanent leader into the role.
Typical engagements:
• Interim Chief Quality / Experience leadership during a search
• Fractional executive oversight of a Stars or Risk Adjustment turnaround
• Advisor to the CEO or board on Stars, Risk Adjustment, and member-experience strategy
Why me:
• I reported directly to the CEO and served as 1 of 5 enterprise Strategy Committee leaders at Providence Health Plan.
• I grew my scope there from 2 direct reports with no budget to more than 70 FTEs, 7 direct reports, and a $15M+ budget.
• I've turned adversarial provider relationships into partnerships and built enterprise data governance where none existed.
• I bring 16 years at Cambia Health Solutions in Enterprise Risk Management, Ethics & Compliance, and HR, with quarterly reporting to the Board.