5 takeaways from our Stars webinar: Moving beyond the Q4 push

Why this matters:

• The bar is rising. About half of Star Ratings cut points got harder this year. Plans can improve and still lose stars.
• Q4 rewards prioritization. Identify the measures and members that can still move, such as recoverable Part D members.
• Year-round work starts now. The biggest gains for Stars Year 2029 take time to build.

Every fall, quality teams run the same sprint, as they try to close as many gaps as possible before December 31. This year, the pressure is higher. CMS is reshaping the measure set, litigation is challenging how ratings are calculated, and cut points moved more than many plans expected. The move to digital HEDIS also narrows the window to modernize. 

That’s why we hosted our recent webinar, More than a Q4 push: How to evolve your Star Ratings program systematically. Cohere Health VP of Commercial Strategy Dan DeSantis moderated a conversation with three Stars and quality leaders:

• Jessica Muratore, founder of Muratore Advisory Services
• Kirsten Selley, manager of Medicare Stars at Priority Health
• Amy Carl, former senior manager of quality improvement at Providence Health Plan

The panel shared practical guidance for the final 90 days of the year, along with advice on building a Stars program that doesn’t hinge on Q4. Here are the five takeaways from the discussion. 

 1. Rethink how you measure performance

CMS is removing 11 measures, including the entire administrative domain, an area where many plans tend to score the highest. Going forward, HEDIS measures will account for approximately 30% of the weighting.

The Stars Year 2027 Plan Preview 2 data paints a challenging picture: roughly half of all cut points have become harder to achieve. 

What counts now is how much you improve compared with the rest of the market. HEDIS is growing in significance while hybrid measures phase out, so plans will need a year-round view of their clinical data, not only during hybrid season.

2. Plan scenarios, then share them early

When CMS signals a shift, early action delivers the highest return. Model the projected impact on your contracts well before final numbers are published–accounting for measures scheduled for removal, as well as those pending judicial review. By building a best case, a worst case, and a realistic case, you can quantify your exposure before it damages your rating.

Once you've mapped out your scenarios, share them early and widely. Star Ratings aren't just a quality team issue. Care management, provider networks, pharmacy, and product all have a stake in the outcome. Bringing these teams into the conversation now makes it much easier to secure their support when you need it. Building habits around proactive alignment and scenario planning also pays off beyond the immediate horizon, laying the groundwork for a year-round strategy that reduces the familiar Q4 scramble.

"If you're going to eventually need assistance from different partners across your organization, transparency is a thousand percent the key to begin that partnership." — Kirsten Selley, manager of Medicare Stars, Priority Health

That transparency should also reach product decisions. Quality leaders belong at the table for bid discussions, because benefit and formulary changes appear in Stars results later.

3. Treat every measure as a priority

With fewer measures, single-weighted measures effectively carry more weight. Providence focused on osteoporosis management in women (OMW) with:

• a $75 member incentive
• mail, email, and phone outreach, coordinated with its largest independent practice association
• a new in-network imaging partner to cut DEXA scan waits of up to six months

The result: an 11% year-over-year improvement and a full star gained on the measure.

Timing matters on a measure like OMW. As highlighted during the webinar, claims can take anywhere from 4 to 12 weeks to appear, which can significantly cut into a six-month window for intervention. By leveraging interoperability feeds and a clinical intelligence platform, health plans can identify those members earlier, while there is still time to take meaningful action. Admission, discharge, and transfer data from care management teams can further support this early detection effort.

4. Prioritize what can still move in Q4

There are about 90 days left, including holidays, PTO, and limited appointment availability. Treating every open gap as equally important is one of the most common Q4 mistakes. 

Here's where to focus instead:

• Know exactly where you stand, measure by measure.
• Prioritize the measures and members that can still move, such as recoverable Part D members.
• Monitor performance weekly.
• Give clinicians prioritized gap lists instead of data dumps. Show them which members need attention, what each needs, and why, ideally within the workflow they already use.
• Clean up your denominators. Check that members belong in each measure, and look for missed exclusions like palliative care, advanced illness, and frailty.

"Q4 is not the time to operate from a broad dashboard and hope the numbers improve. You need a very specific view of where the remaining Stars opportunity is." — Jessica Muratore, founder, Muratore Advisory Services

5. Build a program that makes Q4 easier

Q4 will always involve some kind of push. The difference is whether that push accelerates work already underway or scrambles to start it. Hybrid measures are going away, and every measure now carries more weight, so plans will take on a bigger year-round scope. Most will do it with the same team and resources.

"Q4 should be the icing on the cake. It shouldn't be the cake." — Jessica Muratore, founder, Muratore Advisory Services

With a bigger scope and the same resources, starting early matters. Doing so gives you time to align stakeholders and test interventions before they matter most. The right technology and clinical expertise help teams do more with what they have. Here's what that structure looks like:

• Track measure performance all year. Closing thousands of gaps won't move your rating if they're the wrong gaps.
• Involve clinicians early, with information that fits how they already work.
• Start slow-moving fixes in Q1. Changes like readmission policies take time to show results in the data.
• Gather clinical data year-round. Hybrid season won't be there to catch you up.
• Build a Stars culture. Bring pharmacy, care management, and quality together around shared member populations, such as members with diabetes, instead of splitting measures by department.

‍"Stars culture is really the foundation to success going forward. This has to be done as a plan, holistically, and as a team." — Amy Carl, former senior manager of quality improvement, Providence Health Plan

Missed the live session? Watch the full webinar recording.

Want to see how Cohere Health supports health plan quality teams? Learn more about Cohere Capture™, our AI solution for HEDIS gap closure. It reasons over structured and unstructured clinical data to find evidence that can close gaps, including documentation plans already have.