Medicare Advantage (MA) plans are experiencing a seismic shift in how they are rated and compensated. Our webinar on the MA Star roadmap unpacked the most important changes plan leaders need to understand and incorporate into their plans. Below is a summary of key takeaways from the session and for more information on upcoming Star Changes we published this article previously.
1. Universal Foundation: The Push for Aligned Quality Measures
CMS’s “Universal Foundation” initiative aims to harmonize quality measures across federal programs—from Medicare Advantage to provider organizations and state Medicaid programs. This effort promises to reduce administrative burden, eliminate duplication, and create consistency across care settings.
Key measures expected to gain prominence include:
- Screening for depression
- Substance use disorder treatment engagement
- Social needs screening
While the exact set of measures will shift with each administration’s priorities, the underlying push for standardization is here to stay. For plans, this means preparing for more uniform methodologies and potentially fewer—but more impactful—measures across programs.
2. Changes to Measure Weights
One of the most dramatic shifts underway is in the weighting of Star measures. Beginning with Star Year 2026, more than half of all measures will be impacted by changes in weighting or inclusion of new metrics.
Most notably, the weight of member experience (CAHPS) and operational measures is being cut from 4 to 2. This rebalancing places more emphasis on clinical and pharmacy measures, such as:
- Colorectal cancer screening
- Medication adherence
- New chronic kidney disease measures
Plans that historically relied on high CAHPS scores will need to adjust their strategies and reallocate resources toward clinical performance and member outcomes. Analytics will be critical here—both to understand the evolving scoring structure and to act on improvement opportunities.
3. The Health Equity Index (HEI): Complex, Critical, and Controversial
Replacing the traditional reward factor, the Health Equity Index (HEI) represents a fundamental change in how Star bonus payments are calculated. It introduces a complex two-year blended calculation that incorporates social risk factor (SRF) data, plan-level performance, and industry benchmarks.
While the formula itself is dense, the strategic takeaway is simple: closing care gaps for underserved populations matters more than ever. Plans with higher SRF populations—such as those serving dual eligibles or low-income subsidy recipients—stand to benefit most, but only if they perform well on key quality measures.
The future of HEI is politically uncertain, but the focus on health equity as a driver of outcomes is expected to endure, regardless of administrative changes.
4. Policy Shifts Under a New Administration
With the recent transition to a new federal administration, all eyes are on potential regulatory shifts. Key questions remain around whether HEI will survive intact and how the guardrails and other performance thresholds will be revised.
Two documents are critical for tracking these changes:
- The Medicare Advantage and Part D Rule (typically proposed in the fall)
- The Advance Notice (typically published in the winter)
Both include essential updates to the Star Ratings roadmap and should be closely monitored. The industry should also prepare for supplemental guidance or mid-year rule changes that could impact performance evaluations as soon as 2026 or 2027.
5. The ECDS Transition: A Leap Toward Interoperability
The shift toward Electronic Clinical Data Systems (ECDS) is one of the most technically demanding changes on the horizon. CMS and NCQA are phasing out manual chart reviews in favor of digital interoperability between payers and providers.
In 2024, colorectal cancer screening became the first measure affected, and plans saw performance drop significantly—underscoring how challenging this transition will be.
ECDS fundamentally changes:
- The nature of data submission
- The elimination of sampling
- The demand for real-time, year-round data aggregation
Plans integrated with health systems or those operating in states with strong Health Information Exchanges (HIEs) may fare better initially. Others will need to make targeted investments in technology, partnerships, and data infrastructure to stay competitive.
Strategic Takeaways for Health Plans
As the Star Ratings program enters a new era of complexity, health plans must adopt a proactive, analytics-driven approach. Here are a few guiding principles:
- Anticipate Change: Build multi-year strategies that account for upcoming measure changes and weighting shifts.
- Invest in Data Infrastructure: Prepare for ECDS and health equity requirements with year-round, scalable data capabilities.
- Focus on Equity: Prioritize closing care gaps—particularly in high-SRF populations—to improve both outcomes and Star scores.
- Stay Engaged: Influence policy by participating in comment periods with CMS, NCQA, and other regulatory bodies.
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At Lilac Software, we’re helping leading Medicare Advantage plans not just navigate these changes—but stay ahead of them. Our analytics platform powers everything from forecasting to measure-level intervention planning, giving plans the clarity they need to succeed in an evolving quality landscape.
If you want to explore how Lilac can help your plan drive better Star performance, check out our Star Solution page or start a conversation by reaching out to us via the form in this link.
