Perficient Launches AI Tools for Medicare Advantage Star Ratings Management
Perficient has launched an AI suite to aid Medicare Advantage plans in enhancing their CMS star ratings, which determine access to over $13 billion annually in federal bonus payments. This announcement came a day after the Centers for Medicare & Medicaid Services (CMS) published 2027 ratings indicating fewer plan qualifications. Owned by the Swedish buyout group EQT, Perficient's tools employ predictive analytics, simulation modeling, and agent-driven engagement.
The federal spending on the Medicare Advantage quality bonus program reached at least $13.4 billion in 2026, accounting for approximately 2.3% of projected payments to the program, according to the Kaiser Family Foundation (KFF). Plans rated four stars or higher out of five receive a higher spending benchmark, typically by five percentage points.
While qualifying for these bonuses has become more challenging, with a decrease in both the number of plans achieving four-star ratings and the share of members in bonus-eligible plans, the software targets a metric that is subject to debate. The Congressional Budget Office estimated that abolishing the program could save nearly $100 billion over a decade.
EQT, managing approximately €130 billion, acquired Perficient for roughly $3 billion and delisted it in October 2024. With about 7,000 employees, Perficient operates European delivery hubs in Romania, Serbia, and the United Kingdom.
Meanwhile, Washington is also utilizing AI to scrutinize the same program from a different angle. In May, HHS began screening claims for fraud before payment across Medicare, Medicaid, and the insurance marketplace. The ratings are also being contested in court, with Clover Health successfully securing a recalculation of the 2026 scores, which KFF estimates adds approximately $600 million to 2027 payments.
Alina Maria Stan, co-founder and COO of Tekpon, specializes in connecting people and turning product intuition into moments of discovery. She has led Tekpon’s brand voice, media strategy, and growth plays since 2020, emphasizing human outcomes in every metric.