Glass box quality intelligence for Medicare Advantage

The thesis

Every incumbent in this market sells a dashboard and calls the method proprietary. That is a defensible position right up until a quality leader has to defend a number to a CFO, or an analytics director has to reproduce it. Then opacity stops being a moat and starts being the reason a contract does not renew.

We take the opposite position. Every projection states its inputs, its method, and its uncertainty, and the methodology is published rather than gated. That is a harder product to build and a much harder one to displace, because the buyer can verify it rather than trust it.

Why now

• CMS continues to raise the bar on measure specification and digital quality reporting, which moves the work upstream into data engineering where most plans are weakest.
• Cut points move every year and are published after the measurement year closes, so a plan that waits for certainty has already lost the window to act.
• Health plans are consolidating vendors and cutting analytics spend, which favors a smaller number of systems that replace headcount rather than add reporting.

How we are funded today

Services revenue funds the product build. Managed services, assessments and advisory, and custom development are a first-class business, not a bridge: they put us inside the operating reality of the buyers we sell to, which is where the product requirements actually come from.

The sequence

1. ClearStarsQI. Star Ratings intelligence on published CMS data. No protected health information, no business associate agreement, fastest path to a first answer.
2. ClearStarsQI+. Deterministic workflow AI running on the plan's own member-level rates, under a business associate agreement.
3. ClearStarsLM. The clinical outcomes engine, FHIR first, where quality measurement and clinical decision support meet.

Team

• Bert J. Rico, Founder and Chief Executive Officer. Bert J. Rico, Founder and CEO of ClearStars, is a Medicare Advantage Stars and quality analytics leader with nearly two decades of experience who has contributed to three 5 Star CMS contracts, including a regional plan's first ever 5 Star rating.
• Pedro Cerrate, Chief Operating Officer and Co-Founder. Pedro Cerrate, COO and Co-Founder of ClearStars, is a decorated U.S. Army veteran, former M1 Abrams tank crew leader, and Fort Riley Noncommissioned Officer of the Year who leads the company's project management and executive operations.

Advisors

Named in the data room rather than here, because that is what we have permission to do.

• A former chief executive of two health plans.
• A former chief medical officer at a health plan.
• A health-system VP of Quality Improvement.
• A senior finance consultant in SaaS.

How access works

We do not send materials automatically. Requests are reviewed, and if there is a fit we follow up with an invitation to our data room.

1. You tell us who you are and what you invest in.
2. We review it ourselves. If the fit is not there, you will hear that from us rather than hearing nothing.
3. If it is, we send an invitation and a mutual non-disclosure agreement.
4. Once the agreement is executed, the data room opens. It is hosted in Carta.

Everything we publish about our method stays public and ungated, so you can evaluate the substance before any of this.Start with the methodology.

Compliance posture

HIPAA compliant today. Posture detail is in the Trust Center attrust.clearstars.ai. A SOC 2 Type II attestation is a planned use of funds, and we do not claim it as held.