Beyond the Stars recalculation: Three takeaways for Medicare Advantage quality strategy

Recent developments in Medicare Advantage Star Ratings have created new questions about the future of quality measurement, but they also reinforce an important reality for health plans: quality strategies must be built to adapt.

In late 2025, Clover Insurance Company challenged aspects of CMS’s Medicare Advantage Star Ratings methodology, arguing that CMS used measures beyond its statutory authority and made certain changes without appropriate opportunities for public comment. The court ultimately ruled in Clover’s favor, prompting CMS to recalculate their performance. Subsequently, CMS proactively recalculated other plans’ performance using only HEDIS, HOS, and CAHPS measures, on an upside-only basis, while holding plans harmless from rating decreases.

While long-term implications are still unfolding, the decision highlights several important considerations for Medicare Advantage organizations as they prepare for the future of quality measurement.

1. Clinical outcomes carry more weight every year

One of the most notable implications of the Stars recalculation following the recent ruling is the removal of measures that increased emphasis on HEDIS, HOS, and CAHPS. While the legal decision focused, among other elements, on CMS’s authority to use certain measures, the methodology places greater weight on measures tied to clinical performance, member experience, and outcomes.

This reinforces a broader industry trend: quality programs are increasingly focused on demonstrating meaningful improvements in member health, rather than simply completing administrative activities. This trend is already underway with Star Rating methodology changes, such as the planned removal of 11 administrative measures. 

Regardless of how CMS ultimately redesigns Stars, clinical outcomes will continue to grow in importance across Medicare Advantage quality programs.

Whether the program returns to its previous structure or places even greater emphasis on clinical measures, health plans must develop robust capabilities to identify opportunities, capture evidence, and drive performance improvements. Prioritizing the clinical outcomes that underpin quality performance should remain a constant focus–regardless of how individual measures or methodologies may evolve over time.

2. The Stars landscape reinforces the need for adaptable quality strategies

The Stars recalculation does not represent a complete redesign of the Medicare Advantage Stars program. Instead, CMS made a one-time adjustment to address the immediate implications of the decision, while future changes remain unclear.

CMS has not yet announced how it will approach future measurement years, and a broader redesign of the Stars program is expected. This leaves health plans navigating continued uncertainty around how quality performance will ultimately be evaluated.

Rather than optimizing for a single iteration of their program, health plans should invest in building quality strategies that are flexible enough to evolve alongside shifting requirements.

A truly sustainable quality program must be equipped to handle changing measures, evolving priorities, and growing expectations around value demonstration–all without forcing organizations to overhaul their entire approach every time the regulatory landscape shifts.

3. Year-round quality strategies can help plans prepare for what comes next

Historically, many quality programs have relied heavily on seasonal approaches focused on retrospective chart review and closing gaps near reporting deadlines.

However, as quality measurement becomes increasingly focused on clinical evidence and outcomes, organizations may need to rethink quality as an ongoing operational capability, rather than a point-in-time initiative.

A year-round approach enables plans to:

• Identify quality opportunities earlier
• Capture clinical evidence as care occurs
• Support proactive interventions
• Reduce reliance on last-minute chart retrieval and review

Shifting away from a seasonal quality model can strengthen an organization's readiness, no matter how the Stars program evolves. Health plans that commit to continuous quality improvement today will be better positioned to adapt to future regulatory changes–all while delivering better outcomes for their members.

Preparing for the future of Medicare Advantage quality

The Star developments may continue to evolve through appeals, CMS guidance, and future Stars redesign efforts. But one thing remains clear: clinical quality measures are becoming increasingly important year over year, and success in Medicare Advantage quality will require more than simply responding to individual regulatory changes.

Plans that build adaptable, evidence-driven quality programs focused on clinical outcomes will be better prepared for whatever comes next. As the industry continues to shift, the organizations best positioned for the future will be those who view quality not as a reporting requirement, but as a continuous opportunity to improve care.

Building a future-ready quality strategy

Learn how Cohere Health helps health plans move beyond seasonal quality management with technology that identifies, validates, and acts on clinical evidence year-round.