The 4-Star Playbook is here.A practical guide for Medicare Advantage leaders.
Get the 4-Star PlaybookHealthcare consulting · Value-based care
Value-based care,
built around the
people who live it.
PrimeroEdge Health helps payers, provider organizations, and ACOs improve quality, close care gaps, and lift HEDIS and CMS Star performance — by designing every program around the experience of the member, the provider, and the care team.
Payers · Providers · ACOs
The organizations we partner with
12 solutions, 3 pillars
Organized around member, provider, and care team outcomes
Strategy through delivery
We stay from first assessment to working systems
Healthcare consulting · Value-based care
Value-based care,
built around the
people who live it.
PrimeroEdge Health helps payers, provider organizations, and ACOs improve quality, close care gaps, and lift HEDIS and CMS Star performance — by designing every program around the experience of the member, the provider, and the care team.
Payers · Providers · ACOs
The organizations we partner with
12 solutions, 3 pillars
Organized around member, provider, and care team outcomes
Strategy through delivery
We stay from first assessment to working systems
Who we serve
Value-based care only works when every side of the contract succeeds. We work across all three — so the strategy, the operations, and the technology line up.
Health plans & payers
Medicare Advantage, Medicaid, and commercial plans that need Star Ratings and HEDIS improvement, closer member engagement, and quality programs that perform all year — not just at submission time.
Providers & medical groups
Practices and health systems taking on risk that need care management capacity, prior authorization relief, and workflows that fit the way clinicians actually work.
ACOs & risk-bearing entities
Organizations accountable for total cost and quality that need population health analytics, provider collaboration, and a single view of every attributed life.
What we do
Twelve solutions, organized into three pillars. Each pillar maps to one of the experiences that decide whether value-based care succeeds.
Pillar 01
Member Experience
Members complete screenings, close gaps, and stay engaged when every interaction is easy, timely, and personal. We design the outreach and digital front door that make that happen.
- Member Outreach
- Multi-channel campaigns — voice, text, mail, digital — sequenced around the moments when action is easiest for the member.
- Chat Services
- Always-on chat that answers questions first, books the appointment, and hands off to a human the moment the conversation needs one.
- Assessments
- Health risk and needs assessments designed to be finished, not abandoned — with the results routed straight into care plans.
- Member / Patient 360° Views
- One unified record of coverage, care gaps, history, and preferences, so every conversation starts informed.
Pillar 02
Quality & Outcomes
Ratings are retrospective — the care is happening now. We build the prospective strategy, measure-level plans, and analytics that point teams at the right members all year.
- HEDIS & CMS Star Improvement
- Measure-by-measure improvement plans aimed at the ratings — including the heavily weighted experience measures — not just at the report.
- Quality Measure Management
- A living operating picture of every measure across targets, trajectory, and deadlines, so teams act before they fall behind.
- Care Gap Management
- Prospective gap lists worked into daily outreach and provider workflows, instead of a year-end scramble to catch up.
- Population Health Analytics
- Risk stratification and panel analytics that show which members need attention now — and what to do about it.
Pillar 03
Provider & Care Team Operations
Care teams deliver the outcomes everyone else measures. We remove the friction around them — in care management, authorization, collaboration, and the schedule itself.
- Care Management
- Programs that give care teams the panel, the priorities, and the time to act — with workflows that lead to better care, not busywork.
- Prior Authorization
- Practical clinical and technical flows that cut administrative friction and delays for members, without surrendering clinical review.
- Provider Collaboration
- Shared data, communication pathways, and aligned incentives that make the plan a partner in care — not a barrier to it.
- Provider Schedule Management
- Scheduling designed to close gaps in care: the right visit, with the right provider, at the right time.
How we work: strategy through delivery
Most consulting stops at the recommendation. PrimeroEdge Health is built to own the link between the business goal and the working solution — so a Star measure strategy ends as a running program, not a slide.
Strategy
We assess where you stand — measure performance, operating model, technology — and prioritize the moves with the greatest quality and financial impact.
Operations
We redesign the workflows, roles, and rhythms behind the strategy, so teams can sustain it within real-world constraints.
IT Implementation & Delivery
We lead selection, build, integration, and launch — then measure whether the solution moved the measure it was bought for.
Built, too, as partners. We help you decide with the business case in hand — then make whichever path you choose actually work.
Why “PrimeroEdge Health”?
Primero is Spanish for “first” — first in quality, first in the member’s mind, first to act on a care gap. The edge is what that position earns you in value-based care: a single star or a single measure can decide millions in revenue. We exist to put our clients on the right side of that line.
Experience is the strategy
Measures move when members answer, providers engage, and care teams have time to care. Every engagement starts from those three experiences — not from a system.
Prospective by design
Star Ratings grade care delivered years earlier. We plan next year’s care, not last year’s — instead of chasing last year’s data to report it better.
Between business and IT, on purpose
We sit where business goals meet technology delivery, owning the outcome of both — so initiatives are designed around the measure, not around the ticket queue.
Insights
Field notes and analysis from the work — starting with what separates the top-rated Medicare Advantage plans from everyone else.
Featured briefing
The 4-Star Playbook: what top Medicare Advantage plans do differently
This 19-slide briefing explores why prospective care design beats retrospective reporting — and what that means for your next operating plan.
- Why heavily weighted improvement measures can quietly decide who wins and who falls
- Where top plans stop reporting and start designing care across screening, blood pressure control, and member experience
- Why the fix is prospective care design — not better year-end reporting
Download the full deck as a PDF with your work email.
Start a conversation
Tell us where it hurts. Engagements usually begin with one of these:
- “Our Star Ratings slipped — where do we actually start?”
- “Our care gaps only move in Q4. We need a year-round engine.”
- “Outreach is burning our provider relationships.”
- “We bought the platform. Now we need it to perform.”
Prefer email? Write to us at contact@primeroedgehealth.com
Healthcare consulting for payers, providers, and ACOs. Value-based care strategy, operations, and IT delivery.