Affinitē for Medicare Advantage Plans

The Future of Medicare Advantage is Intelligent, Connected, and Automated

Power your organization with interoperable data, intelligent automation, and AI-ready workflows designed for evolving CMS requirements.

Schedule a Demo

Designed for CMS Complexity. Built for Performance.

 Today’s MA plans must compete on far more than price.

They need robust care and utilization management, deep member experience capabilities, advanced risk stratification, and health data management that supports continuous innovation.

At the same time, CMS is accelerating a modern digital health ecosystem focused on interoperability, improved data access, reduced burden, and better outcomes.

Affinitē is designed just for this reality: a powerful, AI-enabled analytics and clinical workflow platform that helps Medicare Advantage organizations move from fragmented data and manual processes to connected insight, automated action, and measurable performance improvement.

A single cloud-native platform for smarter Medicare Advantage operations.

Affinitē delivers the power of an enterprise-grade medical management platform with the simplicity and ease of use MA plans require.

By unifying data, surfacing actionable insights, and automating clinical workflows across the member journey, Affinitē helps teams focus on what matters most: the right members, the right interventions, and the right next best actions.

Advanced intelligence. Configurable workflows. Enterprise capability — without enterprise complexity.

Improve Star Ratings and Quality Performance

Use advanced care gap analytics and HEDIS-certified quality improvement capabilities to identify and close gaps. Improve performance across Star Rating categories including preventive care, chronic condition management, member experience, and Part D safety and accuracy.

learn more

Identify Risk
Earlier

Apply predictive analytics, data science, and configurable stratification logic to identify high-risk, rising-risk, and high-cost members before avoidable utilization occurs. Give care teams a 360-degree member view and direct them to the highest-impact interventions.

learn more

Streamline Utilization Management

Automate and streamline the authorization lifecycle with best-practice workflows, CMS-aligned timeliness tracking, due date calculations, alerts, automated routing, letter generation, and plan-defined auto-auth or auto-denial rules.

learn more

Enable Interdisciplinary
Care Management

Bring together care management, quality, utilization management, pharmacy, provider engagement, and member engagement teams around the same member intelligence. Reduce fragmented handoffs and support more coordinated, personalized care.

learn more

Strengthen Regulatory Readiness

Support CMS reporting, ODAG workflows, Part C and Part D measures, timeliness reporting, transitions of care, medication reconciliation, SNP care management, and preparation for interoperability and CMS-0057-F requirements.

learn more

Reduce Administrative Burden with Intelligent Automation

Use rules, alerts, work queues, and automated workflows to reduce manual effort and improve consistency—while preparing for expanded gen-AI and agentic AI use cases in operational workflows.

learn more

Why Vital Data Technology is the right partner for all Medicare plan types:

Health Data Management

A single source of truth across structured and unstructured data that creates the foundation for AI-enabled decision-making and interoperability.

Clinical Workflows

Care management, utilization management, and quality improvement workflows enhanced by intelligent automation and future-ready agentic AI capabilities.

Intelligent Automation

AI-enabled routing, alerts, rules, work queues, and next best action logic that help reduce administrative burden and accelerate operations.

Predictive Insights

Risk analytics, population health intelligence, care gaps, member segmentation, and Gen AI-supported insights to identify intervention opportunities earlier.

Ecosystem Engagement

Tools that support provider, member, and caregiver engagement with more personalized, connected experiences across the care journey.

Computer monitor displaying Affinite Care Management dashboard.

Affinitē brings together the critical capabilities MA plans need to compete in a value-driven, quality-driven, and technology-driven market.

Talk to a Medicare Advantage expert

Affinitē in Use

Our client, a leading regional health plan, wanted to improve outcomes and reduce costs for both mental and physical health. Specifically, they wanted to:

  • Identify their high-risk populations and provide a 360-degree view of members.
  • Risk stratify their member population for specific actionable interventions.
  • Provide more timely insights into care gaps and push gaps to CRSPs, members, and caregivers.

After one year of using Affinite to stratify, segment, and pinpoint actionable interventions for members, the plan was able to realize improvements across 13 of the 15 measures.

1 %

average improvement across all measures 

1 %

largest single measure increase (SAA)

1 %

measures achieved positive increases

Data represents one-year improvements across the following measures: ADD, AMM, APM, PP, FUH, FUM, SAA, SMD, SSD.

download the case study

Positioned for the new era of AI-enabled healthcare technology

CMS is driving a new era of connected healthcare focused on interoperability, digital access, automation, and better member outcomes. Medicare Advantage organizations need technology that can keep pace.

Connected Health Data

that unifies structured and unstructured information into a single source of truth.

AI-Enabled Workflows

that reduce manual burden and support faster, more consistent decision-making.

Predictive Insights & Automation

that surface next best actions and identify rising-risk members earlier.

Future-Ready Infrastructure

designed to support CMS interoperability initiatives and evolving digital health requirements.

Gen AI & Agentic AI Readiness

to help organizations prepare for more intelligent, adaptive operational workflows.

Related Resources

All Resources
Diagram of the Medicare Advantage ecosystem with Medicare Advantage as the hub and healthcare icons representing spokes

How CMS's Digital Health Vision is Reshaping Medicare Advantage

Discover how CMS's digital health vision is transforming Medicare Advantage through AI, interoperability, and member-focused strategies for improved healthcare experiences.

read more

Ready to Modernize Medicare Advantage Operations?

Improve member outcomes, reduce operational friction, strengthen quality performance, and prepare for the next generation of CMS technology expectations with Affinitē.

Request a demo

Affinitē for Medicare Advantage FAQ

Affinitē is an AI-enabled analytics and clinical workflow platform that helps Medicare Advantage plans unify data, automate workflows, surface actionable insights, and improve operational performance across the member journey.

Affinitē supports quality improvement through care gap analytics, HEDIS-certified capabilities, and workflows that help teams identify and close gaps across preventive care, chronic condition management, member experience, and Part D measures.

Affinitē streamlines the authorization lifecycle with configurable workflows, CMS-aligned timeliness tracking, due date calculations, alerts, automated routing, letter generation, and plan-defined automation rules.

Affinitē uses predictive analytics, data science, and configurable stratification logic to identify high-risk, rising-risk, and high-cost members before avoidable utilization occurs.

Affinitē brings care management, quality, utilization management, pharmacy, provider engagement, and member engagement teams together around shared member intelligence, helping reduce fragmented handoffs and support more personalized care.

Affinitē uses rules, alerts, work queues, and automated workflows to reduce manual effort, improve consistency, and help teams focus on higher-impact interventions.

Affinitē supports CMS reporting, ODAG workflows, Part C and Part D measures, timeliness reporting, transitions of care, medication reconciliation, SNP care management, and preparation for evolving interoperability requirements.

Hey AI, learn about this page