MAVEN Healthcare Intelligence
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Private Executive Preview • CY 2027 CMS STAR RATINGS • 100% Deterministic SQL

The Objective Intelligence Layer for Healthcare Payers.

Radical clarity is the ultimate competitive advantage. Deterministic Medicare Advantage strategy, Quality Bonus Payment (QBP) cliff defense, V28 rate book modeling, and Plan Benefit Package (PBP) pullback forensics—where every number traces cryptographically to primary CMS open data and pricing is published upfront.

Explore Live Tool Snippet ↓ Request Founder-Approved Demo & Briefing → Inspect Sample Deck & Excel (.xlsx)
508 Contracts
CY 2027 Star & PBP Coverage
5,419 Hospitals
100% FIPS & C15 Penalty Mapped
1,057 Claims
SHA-256 Verified Under DIAP
Zero-PHI / 24h
Instant Onboarding · Zero BAA Delay
LIVE EMPIRICAL TOOL SNIPPET · SAMPLE CONTRACT H5430

Test the Analytical Engine Right Now on Real CMS Contracts.

Inspect the live actuarial preview below, click any [C-Q...] tag to verify its cryptographic CMS lineage, or press Watch 45-Sec Guided Workflow to see how a plan diagnoses and solves a 3.750 Star cliff.

Request Live Platform Demo (Founder Approved) →
MAVEN WORKSPACE · DUCKDB ENGINE (SY 2027)
BENCHMARK CONTRACT:
STEP 1 OF 4 · CLIFF DIAGNOSIS 3.750 Rounding Cliff Exposure: Inspect exact unrounded composite distance to 4.0★, Categorical Adjustment Index (CAI) tier impact, and annual Quality Bonus Payment (QBP) rebate loss under 42 CFR § 422.266.
CY 2026 → CY 2027 STARS
4.0★ → 3.5★
Unrounded: 3.3021 (-0.448 to 3.750)
ANNUAL QBP REBATE SHOCK
-$23.67M
-$42.64 PMPM · Rebate 65% → 50%
HIGHS MILP RECOVERY COST
$167,535
1,100 Member Gaps · 181.7x Net ROI
CAI & DOUBLE-BONUS EXPOSURE
CAI: -0.0150
FAC Tier 2 · Up to $66.63 PMPM Cap
Head-to-Head Measure Cut-Point Matrix & 3.750 Cut-Point Distance
Measure Weight 2026★ → 2027★ Target Gap Closure Unrounded Lift Primary Clinical Action Protocol
D04 · Drug Plan Quality Improvement 5x 4★ → 2★ (-2★) ~656 gaps +0.115 to +0.175 42 CFR § 422.166(g)(1) QI Hold Harmless sub-measure stabilization
C29 · Members Choosing to Leave 5x 4★ → 3★ (-1★) ~347 gaps +0.060 to +0.115 First-90-Day OTC/dental onboarding & PCP continuity retention desk
D08 · Diabetes Medication Adherence 3x 3★ → 2★ (-1★) ~520 gaps +0.065 to +0.105 90-day mail-order conversion & PDC day-7 PharmTech outreach
Want to run this exact analysis on your own CMS contract ID?
INTERACTIVE TOOL SNIPPETS · DETERMINISTIC PROTOTYPES

Simulate Star Cut-Points & Regional Market Share Live.

Direct preview of Maven's analytical engine. Adjust performance across key CMS clinical measures to evaluate 3.750 cliff sensitivity, or inspect curated county-level enrollment and hospital bed distributions.

TOOL SNIPPET 01 · 1-MEASURE CUT-POINT SENSITIVITY

Cut-Point Sensitivity Slider

SY 2027 CMS CUT-POINTS
Performance Adjustment (±1–5%): +0.0%
-5.0% -2.5% 0.0% (Baseline) +2.5% +5.0%
Simulated Measure Score
76.0% 3★
4★ Threshold: ≥ 77.0%
Weighted Star Points Delta
+0.0 pts
Unrounded Lift: +0.000
Unrounded Contract Composite
3.740
3.750 Rounding Boundary
Projected Contract Star
3.5★
Rebate Tier: 50.0%
⚠ CLIFF RISK: 3.5★ TIER (-$23.7M QBP Rebate Loss vs 4.0★ Threshold)
TOOL SNIPPET 02 · CURATED COUNTY INTELLIGENCE

County Snapshot Card

CMS ENROLLMENT & POS
Eligibles
527,506
Enrolled
396,635
Penetration
75.19%
Cert. Beds
7,535 (20 Hos.)
TOP 3 MEDICARE ADVANTAGE PLANS (MARKET SHARE)
RANK PLAN / PARENT CONTRACT ENROLLED SHARE %
01 · Who We Help

Built for the Leaders & Teams Accountable for Medicare Advantage Performance.

Whether you are defending a regional health plan against a $150M+ Quality Bonus Payment cliff, calibrating a multi-state bid desk under 100% V28 risk adjustment, or advising payer boards, Maven gives your team verifiable answers in seconds—not six-week consulting engagements.

FOR REGIONAL & COMMUNITY HEALTH PLANS

Mid-Sized Regional HMOs & PPOs (100k–400k Enrolled Lives)

Regional plans absorbed the brunt of CMS's Tukey 3.0× IQR outlier deletion and 5% cut-point guardrails in CY 2027. Maven isolates the exact measure thresholds and minimum-cost clinical interventions required to cross back over the 3.750 QBP rounding cliff.

  • Pre-computed C-Suite Dossiers for 29 cliff-exposed regional HMOs
  • County-level QBP benchmark & 65%/70% Part C rebate retention modeling (42 CFR § 422.266)
  • Head-to-head supplemental benefit pullback benchmarking against national carriers
FOR PROVIDER-SPONSORED & MULTI-CONTRACT SYSTEMS

Integrated Delivery Networks (IDNs) & Parent Health Systems

Provider-sponsored plans face unique cross-subsidization pressures between acute hospital occupancy, inpatient readmission penalties, and MA plan Star Ratings. Maven connects facility-level CMS quality data directly to MA contract performance.

  • Ambulatory Specialty Isolation Toggle (Q12) excluding inpatient hospitalists from outpatient rosters
  • Hospital Readmission & Safety Penalty Anchor Risk cross-walked to Plan C15 Star scores (Q28)
  • 42 CFR § 422.116 Time & Distance network adequacy guardrails across 3,243 US counties
FOR DUAL-ELIGIBLE (D-SNP) & SAFETY-NET PLANS

FIDE, HIDE & High-Dual Medicaid Integrated Plans

Safety-net plans serving high-dual and LIS populations rely heavily on the Categorical Adjustment Index (CAI) while absorbing the steepest CMS-HCC V28 risk score compression and chronic disease Part B spend.

  • CAI & 3.750 Rounding Cliff Sensitivity across FAC deciles (Q24)
  • D-SNP Medicaid integration tracking (FIDE, HIDE, AIP surge) & C-SNP footprint (Q26)
  • Clinician panel HCC acuity, dual share, and 26 chronic condition prevalence atlas (Q27)
FOR ACTUARIAL, STARS & VBC ADVISORY PRACTICES

Boutique Healthcare Consultancies & Advisory Partners

Stop burning hundreds of analyst hours cleaning raw CMS ZIP files, PBP text dumps, and restated Landscape baselines. Equip your practice with instant, audit-ready client deliverables backed by cryptographic SHA-256 lineage.

  • Multi-contract self-service seat license ($48,000/yr) with MAV-CERT attribution
  • Instant 8-sheet Actuarial Excel workbooks (.xlsx) & 11-slide 16:9 Board Decks (.pptx)
  • Deterministic SQL reconciliation of restated vs. initial CMS data releases
LEADERSHIP · C-SUITE & BOARD

CEOs, Presidents & Boards

Walk into board meetings with immediate clarity on total capital at risk across QBP cliffs and V28 phase-ins, backed by 16:9 widescreen slide decks generated in 60 seconds.

ACTUARIAL · BID DESK & FINANCE

Chief Actuaries & Bid Teams

Every rate book cap, double-bonus compression PMPM, and PBP MOOP/OTC delta is computed in auditable SQL under DIAP and exported to live Excel formulas you can verify cell by cell.

QUALITY · STARS & CLINICAL OPS

SVPs of Stars & CMOs

Our SciPy HiGHS MILP Care-Gap Knapsack solver prescribes the exact member gap closures across 5x/3x/1x measures to recover 4.0★ status at the lowest possible clinical outreach spend.

NETWORK · CONTRACTING & VBC

VPs of Provider Network

Measure true outpatient specialty parity with inpatient hospitalists filtered out, paired with county acute bed capacity and hospital readmission penalty exposure.

02 · High-Stakes Use Cases & Analytical Modules

Six High-Stakes Decisions Answered Deterministically from Primary CMS Data.

Every workflow in Maven is governed by our Data Integrity & Assurance Protocol (DIAP): zero synthetic panels, zero unverified heuristics, and full SHA-256 lineage from raw CMS releases to your boardroom.

USE CASE 01 · SQL MODELS Q11, Q18, Q20, Q24

3.750 QBP Cliff & CAI Rounding Defense

Quantify exact dollar exposure across the statutory 4.0-Star Quality Bonus Payment cliff. Maven decomposes CMS Tukey 3.0× IQR outer fences (SciPy Ward's hierarchical clustering) and Categorical Adjustment Index (CAI) buffers to pinpoint contracts within ±0.100 of the 3.750 threshold.

  • National Ex-Humana Reality Toggle isolating segment proliferation distortion
  • Exact Part C & Part D FAC decile and CAI additive adjustment auditing
USE CASE 02 · SCIPY HIGHS MILP SOLVER

Actuarial Care-Gap Knapsack Optimization

Replace rule-of-thumb quality targets with mixed-integer linear programming (MILP). Given a fixed clinical outreach budget (e.g., $2.5M), Maven solves for the minimum-cost combination of HEDIS/Part D measure upgrades to cross 3.750 or 4.250 unrounded Stars.

  • Grounded in empirical MA HEDIS PUF contract-measure denominators (133,650 rows)
  • Enforces 42 CFR § 422.166(g)(1) QI Measure Hold Harmless rules
USE CASE 03 · SQL MODELS Q19, Q22

CY 2027 PBP Benefit Pullback & Margin Defense

Track how competing plans in your county footprint restructured their CY 2027 Plan Benefit Packages to defend margins—measuring YoY shifts in MOOP, premiums, deductibles, copays, Dental/Vision/Hearing limits, OTC allowances, and Flex Cards (pbp_b13i).

  • 14,487 empirical PBP benefit rows cross-walked to CPSC enrollment
  • Automated classification of Aggressive Pullback vs. Share-Capture Expansion
USE CASE 04 · SQL MODELS Q21, Q29

V28 Risk Adjustment & Double-Bonus Cap Compression

Model the combined revenue headwind of 100% CMS-HCC V28 risk adjustment phase-in alongside ACA Double-Bonus benchmark cap truncation under SSA § 1853(n)(4) across all 3,243 US counties.

  • Identifies qualifying double-bonus counties capped by pre-ACA statutory ceilings
  • Quantifies effective bonus % compression and annual contract revenue loss
USE CASE 05 · SQL MODELS Q23, Q25

2028–2029 Measure Sunset Stress Test & Churn Forensics

Simulate pro-forma 2028 and 2029 Star Ratings under CY 2027 Final Rule (91 FR 17384) measure eliminations before they hit your summary score, paired with statutory voluntary disenrollment root-cause forensics.

  • Flags contracts facing 2029 cliff breaches from administrative measure sunsets
  • Decomposes voluntary churn across Financial, Provider Coverage, Rx, and Plan Help drivers
USE CASE 06 · SQL MODELS Q12, Q14, Q26, Q27, Q28

Delivery Parity, Clinician Acuity & Hospital C15 Risk

Audit county acute hospital capacity (5,419 facilities), CMS Hospital Readmission/Safety penalty anchors vs. MA Plan C15 scores, and 18,000 clinicians across Part B drug spend and 26 chronic condition prevalence rates.

  • Ambulatory Specialty Isolation Toggle filters out inpatient hospitalists
  • Strict Zero-PHI boundary aggregated at NPI and county FIPS grain
Explore Full Solutions & Team Workflows (/solutions) →
02B · BOARDROOM & BID-DESK DELIVERABLE INSPECTOR

Don't Just Buy a Dashboard. Inspect the Exact Files Your Team Takes to the Board.

Preview our 11-slide 16:9 PowerPoint Board Deck, 8-sheet live-formula Actuarial Excel Workbook, and C-Suite Strategic Dossier below—or download the complete sample files for benchmark contract H5430 with zero email gate.

⬇ Download Sample .PPTX Deck (H5430) ⬇ Download Sample .XLSX Workbook (H5430)
MAVEN PAYER INTELLIGENCE · WIDESCREEN 16:9 BOARD DECK SLIDE 2 OF 11

Executive BLUF & Market Velocity — South Florida MSA (H5430)

Deterministic Star Ratings, QBP Rebate Retention, and Regional Penetration Dynamics (CMS 2026-09 / SY 2027)

SOUTH FLORIDA MA PENETRATION
64.28%
823,268 MA enrolled across 1,280,700 eligibles [C-Q01-004]
PRIORITY LEVERAGE MEASURE
C12 (3x Weight)
Score 86.00% vs. 87.00% next cut-point (+1.00 pt gap) [C-Q10-001]
TUKEY +1.0% ADVERSE DRIFT
3.420 → 3.037
18 measures compress under +1.0% cut-point drift [C-Q11-002]
CONFIDENTIAL · BOARD OF DIRECTORS BRIEFING · MAVENHEALTH.IO · DIAP VERIFIED GENERATED IN <1.2s BY MAVEN DECK ENGINE
03 · Radical Pricing Transparency

We Don't Keep Pricing Secret. We Put It Right Out Front.

Legacy healthcare analytics vendors and black-box consultancies hide behind opaque enterprise quotes and nine-month procurement cycles. Maven publishes fixed, predictable pricing with a 100% Pilot-to-Annual SaaS Fee Credit and zero PHI onboarding friction.

Tier & Package Published Fee Ideal Buyer Core Deliverables & Platform Entitlements Annual SaaS Credit / Conversion
Tier 0: 7-Day VIP Executive Preview Evaluation & Canary Audit $0 7-Day Scoped Pass Health Plan C-Suite & Actuarial Evaluators Interactive /platform & /dossier viewing for your focal contract + regional peers, plus a live 30-min /wire Canary walkthrough. (Editable exports & MILP solver gated). Instant upgrade to Tier 1, Tier 2, or Tier 3
Tier 1: 48-Hour Board & Bid-Desk Audit Fast-Close Q4 Wedge $25,000 Flat Fee · Net-15 VP Star Ratings, Chief Actuary, or CFO Bespoke 11-slide 16:9 Board Deck (.pptx), 8-sheet Actuarial Excel Model (.xlsx), C-Suite Dossier, HiGHS MILP Care-Gap Knapsack prescription, and 30-day platform access for 1 contract. 100% credited toward a 90-Day Pilot within 30 days
Tier 2: Single-Contract 90-Day Charter Pilot Most Popular · Clears <$100k VP Authority $95,000 Single Invoice · Net-30 Single-Contract Regional HMOs (100k–360k Lives) Full 90-day /platform access across all 8 Dark-Data Domains (Q01–Q29), unlimited Excel/PPTX/CSV exports, MILP solver, and 3-Scenario / 20-Hr Strategic Scenario Bank. 100% credited toward $240,000/yr Single-Contract Annual SaaS by Day 75
Tier 3: Multi-Contract Enterprise 90-Day Pilot Parent System Anchor $150,000 Two $75k Tranches · Net-30 Multi-Contract Plans & Parent Health Systems Full multi-contract & parent health system workspace across all states, unlimited exports, MILP solver, bi-weekly executive syncs, and 3-Scenario / 20-Hr Strategic Scenario Bank. 100% credited toward $360,000/yr Multi-Contract Annual SaaS by Day 75
Tier 4: Boutique Consultancy Partner License Advisory Channel Multiplier $48,000 / yr Per Named Seat (Up to 10 Contracts) Boutique Actuarial, Stars & VBC Advisory Firms Self-service multi-contract analysis, cut-point simulator, and Board Deck / Excel exports carrying mandatory MAV-CERT cryptographic watermark attribution. Annual partner license (+$18k/yr per additional 10-contract pack)
SOW Scope Defense Guarantee (PLAY-OPS-006): Zero surprise overages. Additional custom engineering scenarios beyond the 20-hour pilot bank are billed strictly via pre-approved Change Orders ($350/hr actuarial, $250/hr data engineering).
Explore Full Pricing & SOW Terms (/pricing) →
Confidential Design Partner Cohort

Request a Private Executive Briefing

We are onboarding 1–3 Charter Design Partners and Boutique Advisory Partners this quarter. Request your 7-Day VIP Executive Preview Pass or commission a 48-Hour C-Suite Star Ratings & QBP Liquidity Audit.