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You cannot control CMS raising cut points. But you can control how you respond.
The 2026 requirements are clear. CMS is implementing risk-adjusted measures focused on Social Determinants of Health. The new Excellent Health Outcomes for All reward ties STAR ratings exclusively to performance among your hardest-to-engage members—Dual-Eligible, Low-Income Subsidy, and disabled populations.
These changes represent a fundamental shift in how Medicare Advantage plans will be evaluated. What worked last year won’t work next year. The question is not whether these changes will impact your plan. The question is whether you’ll be ready.
Why Waiting Until 2026 Will Be Too Late
Building an effective adherence strategy for high-risk populations requires preparation. You need to configure data infrastructure for real-time claims analysis. You need to establish care teams proficient in both pharmacy and medical channels. You need to create data-sharing protocols with providers, pharmacies, and strategic partners.