A Pager Health Performance Review | Beating the MA Market
With the release of the 2025 Medicare Advantage (MA) Star Ratings in October, many MA plans are asking a billion-dollar question.
That’s because bonus payments to MA plans dropped from $12.8 billion in 2023 to $11.8 billion in 2024, a 7.8 percent decrease.
Fortunately, Pager Health has a proven track record helping MA plans improve their Star Ratings by providing both clinical support and wellbeing programs on a single integrated platform.
Indeed, MA plans supported by Pager Health’s digital solutions, outperformed the market average in all nine of the 2025 Star Rating domains.
In today’s blog, we’ll delve into the measure level details where Pager Health’s MA plans performed better than others.
Breast Cancer Screening (CI)
Plans Supported by Pager Health: 4.0
Average Market Score: 3.4
Primary Data Source: HEDIS
Weighting Value: 1
Breast cancer has the highest treatment cost of any cancer, with a total annual medical cost of almost $30 billion. Screening every two years for women aged 50 to 74 reduces breast cancer deaths by 26 percent compared to no screening. Medicare Advantage patients have higher screening rates for breast cancer (61 percent) than traditional Medicare patients (54.7 percent).
Engagement Insight
Pager’s solutions improved engagement rates through gap identification, scheduling support and member rewards.
Colorectal Cancer Screening (C2)
Plans Supported by Pager Health 4.8
Average Market Score 3.4
Primary Data Source: HEDIS Patient Level Data
Weighting Value: 1
Colorectal cancer has the second highest treatment cost of any cancer, with an annual treatment cost of more than $24 billion. An estimated 85,260 Americans aged 65 and older were diagnosed with colorectal cancer in 2023. Seniors account for 56 percent of colorectal cancer cases and 68 percent of deaths. Colorectal cancer screening by colonoscopy is recommended at least every 10 years for seniors until age 75 and selectively from age 76 to 85.
Engagement Insight
Because the interval between colorectal cancer screenings can be up to 10 years, it’s easy for members to forget about a scheduled appointment. To address this issue, Pager Health’s proactive text messages in the months leading up to a screening can serve as reminders as well as educate members about the clinical importance of having a colorectal screening. This proactive outreach improved education and motivated members to complete screenings at a higher rate.
Diabetes Care – Eye Exam (C9)
Plans Supported by Pager Health 4.8
Average Market Score 3.4
Primary Data Source: HEDIS
Weighting Value: 1
In the United States, more than 29 percent of people over the age of 65 have diabetes, about 16.5 million seniors. More than 25 percent of these seniors have diabetic retinopathy, the leading cause of blindness in the United States. Early detection and treatment of diabetic retinopathy is critical because retinal damage often begins long before symptoms ever develop. Even with the threat of blindness, compliance with an annual diabetic eye examination remains poor. Only 54 percent of Medicare Part B beneficiaries are up to date with their exams. But with early detection and treatment the risk of blindness from diabetic retinopathy decreases by 95 percent.
Engagement Insight
Studies have found that seniors who are experiencing food, housing or mental health issues are less likely to see an eye care provider. Low health literacy, lack of awareness about the importance of screening, transportation issues, and financial concerns or confusion about coverage are other obstacles that hinder screening compliance. At Pager Health, our interactive health assessment gathers data about each member’s social determinants of health (SDoH) to help identify and address these issues on an individual basis.
Diabetes Care – Blood Sugar Controlled (C10)
Plans Supported by Pager Health 4.5
Average Market Score 3.68
Primary Data Source: HEDIS
Weighting Value: 3
Diabetes care blood sugar is an outcomes measure. That means improving member health is the only indication of success. The goal is not only to lower members’ blood sugar but to also manage those members who are at risk. An estimated 2.7 million people aged 65 and older have diabetes but are undiagnosed.
Engagement Insight
Effectively managing diabetes requires personalized care plans and engagement tools to meet members where they are. Pager’s solutions not only work with diabetic members, but they also help plans identify those at risk of developing the condition. Through Pager Health’s wellbeing program, ReallyWell, members can receive coaching services, talk to a nurse, follow a personalized care plan, track their exercise goals, review educational materials about making healthy lifestyle choices, and receive personalized proactive texts reminding them to monitor their blood sugar level.
Getting Care and Appointments Quickly (C20)
MA Plans Supported by Pager Health 4.0
Average Market Score 3.46
Primary Data Source: CAHPS
Weighting Value: 4
The patient experience measures, weighted at 4x for 2025 before going to 2x, are critical to a plans performance. Understanding how members percceive key aspects of care helps plans identify interventions to meet members’ needs and drive positive opinions.
Engagement Insight
Pager offers digital surveys which can be delivered iteratively to provide plans with a snapshot of member experience. Plans can then use those survey results to view care through the members’ eyes and to identify unmet needs.
Looking for a partner to support your MA plans? Contact Pager Health and discover how our digital-first "one-size-fits-one” approach to engagement, care coordination, and risk management achieved a 40 percent higher gap-closure rate when MA members digitally opted in to our gap closure program.