Who We Help & How Maven Solves the Hardest Problems in Medicare Advantage.
Maven replaces fragmented CMS spreadsheets and $500,000 black-box consulting projects with a single, deterministic analytical engine (`Q01`–`Q29`). Below is our complete mapping of buyer personas, organization archetypes, and the 8 empirical data domains powering the platform.
1. Solutions by Executive & Functional Role
Capital Defense & 60-Second Board Readiness
When a contract drops from 4.0★ to 3.5★, the CEO faces immediate board scrutiny over lost Quality Bonus Payment (QBP) benchmarks and Part C rebate percentages (65%/70% down to 50% under 42 CFR § 422.266).
Maven Deliverable: 1-click 11-slide 16:9 PowerPoint Board Deck (.pptx) and C-Suite Dossier quantifying exact PMPM shock, peer comparison in your metro cluster, and the minimum clinical budget required to restore 4.0★.
CY 2027–2028 Bid Calibration, V28 & Double-Bonus Caps
Actuarial bid teams must balance 100% CMS-HCC V28 risk score phase-in against SSA § 1853(n)(4) pre-ACA statutory benchmark caps and competitor supplemental benefit pullbacks.
Maven Deliverable: 8-sheet live-formula Actuarial Excel Workbook (.xlsx) uniting County Rate Books, Double-Bonus Cap Compression (Q29), V28 RAF drag (Q21), and PBP Benefit Pullback deltas (Q22).
HiGHS MILP Care-Gap Knapsack & Cut-Point Defense
Quality teams waste millions chasing unweighted care gaps or getting blindsided by Tukey 3.0× IQR outer-fence jumps, Categorical Adjustment Index (CAI) shifts, and 2028–2029 measure sunsets.
Maven Deliverable: SciPy Ward's hierarchical cut-point decomposition (Q18), CAI 3.750 cliff buffers (Q24), 2028–2029 Sunset Stress Test (Q25), and exact HEDIS PUF care-gap closure quotas.
Ambulatory Specialty Parity & Hospital C15 Risk
Standard NPPES provider counts are distorted by inpatient hospitalists who never take outpatient MA referrals, while local anchor hospitals with high CMS readmission penalties drag down Plan C15 Star scores.
Maven Deliverable: Ambulatory Specialty Isolation Toggle (Q12), 42 CFR § 422.116 Time & Distance guardrails (Q14), Clinician Acuity Atlas (Q27), and Hospital Penalty vs. C15 Matrix (Q28).
2. The 8 Empirical Dark-Data Domains (`Q22`–`Q29`)
| Domain | Analytical Capability | Primary CMS Warehouse Source | Key Executive Decision Unlocked |
|---|---|---|---|
| D1 (`Q22`) | CY 2026 → 2027 PBP Benefit Pullback & Margin Defense | raw.pbp_benefits (14,487 rows) & core.fct_pbp_benefit_changes |
Identify where competitors raised MOOP/copays or cut OTC, Flex Card, and Dental/Vision/Hearing allowances to avoid adverse selection. |
| D2 (`Q23`) | Voluntary Disenrollment Root-Cause & Churn Forensics | raw.stars_cells (12,824 rows, SY 2023–2026) & core.fct_star_disenrollment_reasons |
Diagnose whether member churn is driven by Financial Reasons, Doctor/Hospital Coverage, Rx Formulary, or Plan Service. |
| D3 (`Q24`) | Categorical Adjustment Index (CAI) & 3.750 Cliff Sensitivity | stg.stg_star_cai (3,941 rows, SY 2023–2027) & core.fct_star_cai_sensitivity |
Pinpoint contracts saved or penalized by CAI across Part C/D FAC deciles within ±0.050 of the 3.750 QBP rounding threshold. |
| D4 (`Q25`) | 2028–2029 Star Measure Regulatory Sunset Stress Test | core.measure_sunset & core.fct_star_sunset_simulation (91 FR 17384) |
Simulate pro-forma 2028 and 2029 Star Ratings after scheduled CMS measure eliminations to prevent surprise future downgrades. |
| D5 (`Q26`) | D-SNP Medicaid Integration & C-SNP Disease Footprint | raw.snp_plan (3,311 rows) & core.fct_snp_integration_footprint |
Benchmark FIDE, HIDE, and Applicable Integrated Plan (AIP) growth (+80.8% YoY surge) and C-SNP chronic disease specialization. |
| D6 (`Q27`) | Clinician Panel Acuity, Part B Spend & 26 Chronic Conditions | raw.clinicians (18,000 providers, 85 cols) & core.fct_county_clinician_acuity |
Evaluate county provider panels by dual-eligible share, average HCC risk score, Part B drug spend, and 26 chronic/behavioral conditions (Zero-PHI). |
| D7 (`Q28`) | Hospital Readmission & Safety Penalty Risk vs. Plan C15 | raw.hospitals (5,419 certified hospitals) & core.fct_county_hospital_safety_risk |
Correlate local acute hospital readmission and safety penalties against MA contract C15 (Plan All-Cause Readmissions) Star ratings. |
| D8 (`Q29`) | Double-Bonus Cap Compression & Statutory Ceilings | core.fct_county_benchmarks (6,456 county-year rows) & core.fct_county_double_bonus_compression |
Quantify exact PMPM bonus truncation in qualifying double-bonus counties capped by pre-ACA statutory benchmark ceilings (SSA § 1853). |
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