CMS turns up the heat on health plan Star Ratings programs

This article was authored in collaboration with Jessica Muratore, Founder of Muratore Advisory Services, and reflects her perspective on the future of Medicare Advantage Star Ratings.

The 2027 Medicare Advantage and Part D Final Rule introduces significant changes to the Star Ratings landscape, demanding immediate attention from the industry, but most importantly, health plan quality leaders. CMS is implementing several impactful adjustments, including removing high-performing administrative measures, adding a behavioral health HEDIS measure, and further advancing the shift toward outcomes-driven, member-centered, and operationally integrated quality performance. These modifications create a more concentrated, higher-stakes program, substantially narrowing the margin for error and making it more challenging to achieve high ratings.

Meanwhile, the competitive landscape is intensifying. According to CMS's 2026 Medicare Advantage and Part D Star Ratings Fact Sheet, the enrollment-weighted average MA-PD Star Rating declined from 4.14 in 2023 to 3.98 in 2026, and only about 40% of MA-PD contracts earned 4 Stars or higher. These trends underscore the growing difficulty of achieving and maintaining top performance as CMS continues to evolve the program and measure cut points increase. 

For plans operating near the all-important 4-Star threshold, the implications are significant, and the time to act is now.

What changed: A summary of the major provisions

1. Removal of 11 Star Ratings measures‍
   CMS is eliminating 11 measures, most of which focus on administrative processes, from the Star Ratings program. CMS was direct about its intent. In the Final Rule, CMS stated:
   
   “As the Part C and D Star Rating program continues to evolve and align with the measures included in the Universal Foundation, a strategy to align measures across the agency’s quality and value-based care goals, we proposed to simplify and refocus the measure set on clinical care, outcomes, and patient experience of care measures where performance is not topped out and where there is more variation in performance across contracts. Reducing the number of measures would increase the focus on the remaining measures, including those consistent with the Make America Healthy Again (MAHA) initiative, such as Reducing the Risk of Falling and Monitoring Physical Activity. Additionally, reducing the number of measures is consistent with recommendations from MedPAC and other interested parties that CMS consider having fewer measures in the Part C and D Star Ratings program.”
   
   CMS is intentionally concentrating the program around fewer, more meaningful measures. Fewer measures mean each remaining measure carries more weight and more exposure to single-measure movement. The remaining measures have become more consequential than ever before.
   ‍
2. Increased weight on HEDIS
   The measure weight redistribution effective in Stars Year 2029 (Measurement Year 2027) means HEDIS will carry even greater influence on overall ratings and financial performance moving forward.
   
   When you combine that increase with the removal of administrative measures, which had buffered the relative influence of clinical measures, the cumulative shift toward clinical outcomes and member experience is substantial.
   
   ‍Stars Year 2029 (Measurement Year 2027) Measure Distribution

‍

3. A new behavioral health measure
   Depression Screening and Follow-Up (Part C) (DSF-E) is being added as a new measure starting in 2027, filling an important gap, as there are currently no behavioral health measures in the Star Ratings program. This is a meaningful signal of CMS’s intent to integrate behavioral health into Star Ratings. Plans should expect additional behavioral health measures to follow in future rulemaking.

4. Health Equity Index (HEI) is out, and Reward Factor is in
   Even though HEI was effective for the entire Measurement Year 2025, CMS announced it will not implement HEI, but will instead continue to include the historical Reward Factor in Star Ratings. For those of you keeping track, HEI is out, even though it was never in, and Reward Factor is in, even though it was never out.
   
   Why? Well, CMS said they would rather incentivize improvement efforts on “clinical care, outcomes, and patient experience, to refocus the Star Ratings measure set” instead of focusing on certain populations like those included in HEI.

The bigger picture: Why this matters now

The removal of 11 measures, including the entire administrative domain, means plans lose measures that were more solely within their control. This places more weight on clinical outcomes, medication adherence, member experience, and HOS, which are harder to influence without deeper operational alignment. As a result, these changes fundamentally shift the Star Ratings strategy from a seasonal, campaign-based effort to a daily operating discipline. Plans can’t rely on year-end pushes or administrative measure buffers anymore. Plans must manage performance in real time, year-round.

What health plans should do

1. Operationalize Star Ratings performance as a daily management system rather than a seasonal initiative
   
   Star Ratings performance should be embedded into weekly operational reviews, not revisited only during year-end reporting cycles or Q4 recovery efforts. Start by leveraging the 2027 Final Rule to engage and educate executive leadership on the significance of these changes, particularly the financial impact associated with declining performance. Turn Stars governance into an enterprise operating model with cross-functional structures that make Star Ratings performance everyone’s responsibility, drive accountability, and create transparency across the organization.

2. Plans need to become far more precise in member and provider engagement
   ‍
   The margin for error is gone. Plans must identify the specific members, providers, and operational breakdowns that impact performance, and deploy more personalized, longitudinal engagement strategies rather than one-off campaigns. Start small. There’s no need to boil the ocean. Focus on a single measure or a related set of measures, and identify scalable operational changes that can positively influence member engagement, provider performance, or internal workflows.

3. Invest aggressively in data integrity and integration
   
   Plans need integrated data pipelines across HEDIS, pharmacy, care management, provider reporting, and member experience so teams operate from a consistent and trusted source of truth. The industry does not suffer from a lack of data. The challenge is to pull fragmented data together, operationalize it effectively, and use it holistically to drive both performance improvement and a better member experience.

These regulatory changes will impact your plan–now is the time to invest in new strategies. The window to build and refine these approaches before the measurement year locks in is narrower than it appears. Because HEDIS rewards sustained clinical engagement, this change also compels a shift away from seasonal tactics toward year-round, long-term quality programs, aligning perfectly with NCQA's future direction.

The plans that will thrive under this new structure are those that begin thinking strategically today. With Cohere Capture™, health plans can capture more than just gaps; they can capture the value hidden within their existing clinical documentation. By identifying HEDIS-compliant evidence already in the plan's medical charts and records, Cohere Capture helps convert previously overlooked information into potentially reportable quality outcomes. The result is a more efficient quality operation that helps reduce unnecessary chart retrieval efforts, accelerate gap closure, and helps plans maximize the return on data they already own. 

Ready to capture more value from the data you already have? Learn how health plans are leveraging existing clinical documentation to improve HEDIS and Star Ratings performance and drive greater return on their quality operations investment.