Upcoming Changes in MA Stars

Medicare Advantage Stars and the Rod of Asclepius



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The Medicare Advantage (MA) Star Program is Constantly Changing

Benjamin Franklin once said that “nothing is certain except death and taxes.” Similarly, we can also be certain that the Medicare Advantage (MA) Star program is always going to change and that raises great challenges for MA plans. The Star program is complex and ever-evolving. Since there are multiple facets of the program, we tend to see changes – sometimes tweaks and sometimes major shifts – in Star each year. This is what makes the program so difficult to master. Before COVID, in 2021 48.5% of all contracts and 76.8% of members were in 4 Star or greater plans. In 2024, those numbers dropped to 42% of contracts and 73.7% of members. 

Why has Star power dropped?

Why these major reductions in the Star power of plans? New measures are being introduced – some of them with great complexity. It is much harder to perform well on such measures, especially ones that are not member-based but event-based. 

Measure weights are changing, which can shift the relative importance of the many types of measures from one category to another. 

And the Centers for Medicare and Medicaid Services (CMS) has also introduced methodologies to crank up overall performance.  The Tukey outlier change made it harder for plans to achieve as low and high outliers have been set aside before calculating Star cut points. A new health equity index (HEI) will replace the simpler reward factor in 2027 (note that data from measurement years 2024 and 2025 will be used, so HEI really is here now!).

What must MA plans do to achieve better results?

As such, MA plans have to do a few things to achieve high Star scores consistently.

First, they have to track the myriad of changes each year. CMS does not make this an easy task. Changes and additions are hidden in various rules and notices. Announced changes could occur years prior. Assembling the so-called “Stars road map” is critical for a plan.

Second, MA plans need to constantly hone their measure remediation strategies. While the goal is to improve quality outcomes for everyone in all areas, we know that budgets do not always allow unfettered resources. Plans must strategically target areas that will drive not only quality outcomes for members but also maintain high Star ratings.

Third, given all this complexity, MA plans really need to adopt technologies that allow them to swiftly assemble data, analyze it, and remediate poor performance by engaging both members and providers. Offline and manual approaches continue to dominate the industry, but these legacy practices do not promote consistent high quality performance. 

What is changing in Star?

To help get you started, here are some reminders about upcoming changes. We will write about them at this resource center often – so come back here to check out the planned changes in Star.


Reminders on 2025 Stars (Measurement Year 2023):

Plans continue to remediate measurement year 2023 for the 2025 Star announcement in October 2024. 

  • See Page 129 of 2025 Final Notice for final 2025 Star measures with weights: https://lnkd.in/e9Fe7hpB
  • The Plan All Cause Readmissions measure moves to a 3-weight. This is a measure that many plans have had achievement problem on in the past.
  • The National Committee for Quality Assurance has converted the Breast Cancer Screening measure to Electronic Clinical Data Systems (ECDS) status. This is the conversion to a fully electronic measure and the eventual removal of manual chart reviews. We will see additional measures converted over time. It does not mean that manual chart reviews are gone or data cannot be used. It just needs to meet the standard outlined by NCQA. See this important NCQA web page for more details: https://www.ncqa.org/hedis/the-future-of-hedis/ecds-frequently-asked-questions/ A strategy here is key.
  • There is the removal of the following question from the Getting Appointments and Care Quickly CHAPS measure: “In the last 6 months, how often did you see the person you came to see within 15 minutes of your appointment time?”.
  • The deadline for plans to request Independent Review Entity (IRE) review of appeals data is June 28, 2024.
  • The deadline for plans to request CMS to review Complaints Tracking Module (CTM) data is June 28, 2024


Reminders on 2026 Stars (Measurement Year 2024):

  • The Colorectal Cancer Screening measure is converted to ECDS.
  • The Patients’ Experience and Complaints and Access measures move from 4 weights to 2 weights. The impact here is that the relative importance of Clinical, Medication Adherence, and Quality Improvement measures increase dramatically. If a plan did well on CAHPS member surveys as an example and poorly in other areas, this could impact Star achievement. On the flip side, if a plan did poorly on CAHPS member surveys as an example and better in other areas, this could be a benefit. So, look at your other measures’ achievement and how you might boost them further. And remember, CAHPS member surveys are still very important – there are a lot of questions and they have a 2 weight.
  • We will see two HOS Measures returned at 1 weights:
    • Improving/Maintaining Physical Health
    • Improving/Maintaining Mental Health
  • The Kidney Health Evaluation for Patients with Diabetes becomes part of Star (at a 1 weight). 
  • Continuous enrollment will be used for Medication Adherence measures and the SUPD measure.