The Health Outcomes Survey (HOS) is taking on a much more prominent role in the Medicare Advantage (MA) Star Ratings program. With the introduction of two newly returning measures—now worth a combined six weighted points—plans that once deprioritized HOS will need to reevaluate their approach. These measures are not only significant in their scoring weight but also complex in their structure, requiring longitudinal tracking of a member’s self-reported health status over a two-year period.
So, how can Medicare Advantage organizations prepare for this shift and improve HOS performance?
Understand What HOS Measures—and Why It Matters
HOS is fundamentally about measuring members’ perceived changes in health status over time. It covers mental health (such as depression and social isolation), physical functioning (including limitations with activities of daily living, or ADLs), and overall well-being. Because these are longitudinal measures, success isn’t about a single moment in time—it’s about improvement or stability in health over two years.
To do well, plans must identify early which members are at risk of a decline in health status and act accordingly.
Use Population Health Analytics, Not One-Off Outreach
Improving HOS scores isn’t about one-size-fits-all outreach. It requires a population-level approach that can track and predict changes in physical, emotional, and social health across the entire member base. Plans need to invest in advanced analytics that can:
- Identify members at risk of decline based on prior HOS responses, health risk assessments, claims, and case management notes
- Surface patterns around key risk factors like depression, social isolation, or deteriorating mobility
- Connect those insights to actionable programs in care management or social services
Plans that rely only on episodic outreach or static segmentation will fall behind.
Integrate HOS Into Case Management and VBC Models
Some of the most forward-thinking plans are beginning to embed HOS performance into their value-based care models, tying provider incentives to improvements in patient-reported outcomes. Case management teams are also evolving their models to proactively engage members who report being frustrated with their health or show signs of mental health struggles.
These interventions go beyond clinical care and may include:
- Mental health services for members showing signs of depression
- Community-based resources to address social isolation or support with daily living
- Tailored case management that reflects members’ evolving perceptions of their health—not just clinical markers
Make Better Use of Health Risk Assessments
Health risk assessments (HRAs) are a common tool but often underutilized. High-performing plans are not just collecting this data—they’re using it to identify unmet needs and coordinate timely interventions. This means integrating HRA findings into care team workflows, stratifying members dynamically, and ensuring that social and behavioral health concerns are not overlooked.
Bottom Line
With HOS now carrying significantly more weight in Star Ratings, plans need to shift from reactive check-ins to predictive, data-driven interventions. This requires unifying clinical, behavioral, and social data, empowering care teams with the right insights, and treating HOS as a strategic lever—not just a compliance requirement.
The plans that succeed will be those that build intelligent, integrated workflows—powered by robust analytics—that continuously track changes in member-reported health and respond in real time.