(Podcast) MA Star Year 2026 Data Deep Dive: Stability Arrives, but Challenges Intensify

In a recent edition of The Healthcare Labyrinth Podcast, Lilac’s Marc Ryan unpacked the most recent Star rating data to tease out key insights. The podcast is embedded above and below is a summary. You can subscribe to The Healthcare Labyrinth Podcast on your favorite podcasting app.

The 2026 Star Ratings results reveal a Medicare Advantage (MA) landscape at a turning point. After years of declining performance following the COVID flexibility era, Star ratings have finally stopped their slide. But stabilization should not be mistaken for recovery. The industry remains well below historical norms, measure volatility persists, and new regulatory requirements will make 2027 even more challenging.

For health plans, this moment represents both a warning and an opportunity: a reminder that Stars success now hinges on real-time analytics, operational precision, and scalable member engagement approaches.

1. The Industry Picture: A Pause, Not a Rebound

Across the 481 contracts rated in both SY25 and SY26:

• 29% dropped by ≥0.5 stars
• 26% improved by ≥0.5 stars
• 45% showed no change
• Average contract score increased slightly (3.63 → 3.65)
• Enrollment-weighted average rose from 3.92 → 3.98
• 40% of contracts achieved 4★+ (flat vs SY25)
• 64% of MA enrollment is in 4★+ plans

Takeaway:
The industry has stabilized, but at a low plateau. Many plans remain stuck in the 3–4 star range, and the proportion of high performers continues to shrink.

2. How the Major Plans Performed

Performance among the largest MA organizations shows a wide split:

Interpretation:
Big-plan inconsistency continues to pull down the national average. Kaiser remains a standout, while others either plateau or decline.

3. The New Normal: More Plans Clustering in the Middle

The distribution of contract ratings has shifted meaningfully since 2022:

This illustrates a long-term structural shift:

• Far fewer contracts sit at the top.
• The “middle tower” continues to grow.
• Lower-performing contracts have multiplied dramatically.

4. Measure-Level Insights: Where Plans Improved, and Where They Struggled

Improving Measures

• Controlling high blood pressure
• Statin therapy for cardiovascular disease
• Medication reconciliation post-discharge
• Colorectal cancer screening (helped by guardrails and ECDS shifts)
• Call center performance (Part C & D)

Declining Measures

• Breast cancer screening
• Care for older adults – pain assessment
• Bladder control
• Plan all-cause readmissions
• Follow-up after ED visits

Medication Adherence Remains a Pain Point

All three adherence measures remain flat or slightly down (scores 3.1–3.3), and all are triple-weighted in SY27, making them outsized drivers of upcoming financial outcomes.

5. What’s Coming in Star Year 2027

Plans should prepare for a significantly harder measurement year:

New High-Risk Medication Measures

• Concurrent opioid + benzodiazepine use
• Anticholinergic polypharmacy in older adults

These require earlier detection and faster, targeted outreach. This needs to be done before most data systems typically surface overlap issues for optimal results.

Methodology Shifts

• EHO4All replaces the Reward Factor (likely reducing score contribution for many plans)
• Expanded use of ECDS measures
• Broader age band for colorectal cancer screening (45–75)
• Return of functional status assessment
• Removal of chart review for the diabetes eye exam

Implication:
Operational agility will become even more important as CMS rules diversify and intensify.

6. The Strategic Imperative: Better Data, Faster Execution

Star Ratings performance is no longer just a function of clinical quality. It is a function of data clarity, intervention speed, and scalable execution.

This requires:

1. Unified and Timely Data Infrastructure

Plans must be able to see measure risk in real time, not months late due to fragmented claims, pharmacy, and ECDS flows.

2. Predictive Identification of At-Risk Members

Early detection of emerging medication issues or declining adherence is critical, particularly for overlapping-medication measures where compliance can be lost early in the year.

3. Scalable Outreach and Follow-Through

As measures grow in complexity, traditional call-center-only approaches cannot keep up.
Agentic AI-driven workflows — blending automated voice, scripting, digital messages, and staff routing — can help close gaps efficiently at scale.

4. Continuous Scenario Modeling

With multi-year lags and yearly methodology changes, plans increasingly need to model:

• Measure trajectories
• Member-level risk
• Financial impact under multiple scenarios

7. A More Sustainable Path Forward

The stabilization in SY26 shows that industry performance is not in free-fall. However, the underlying challenges have not gone away. In many respects, the tough environment is a sign that the program is working as intended: constantly raising expectations for quality and member experience.

A few well-placed capabilities will differentiate the plans that rise:

• Strong analytics to interpret measure movement
• Integrated data systems that minimize lags
• Workflows that connect insight → action → outcome
• Smart automation and agentic AI to expand operational reach
• Leadership alignment around continuous-year Stars management

These elements give plans not only the ability to respond, but to get ahead.

Lilac Software works with plans to support these capabilities — particularly in data readiness, measure analytics, and agentic-AI-powered engagement — but the message is broader than any one solution: Stars success now depends on building a system that can think, adapt, and act continuously.

———————————————–

Lilac has deep expertise in helping MA plans reach 4+ Star performance through AI powered technology.  Reach out here to start a conversation with the Lilac team about how we can help your plan.