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The Medicare Advantage (MA) Star Ratings program is undergoing a fundamental shift. Instead of primarily rewarding health plans’ operational compliance and administrative performance, the focus is moving toward measurable clinical outcomes and member experience.
As a result, medication management will increasingly influence both Star Ratings performance and financial outcomes, making it a critical area for plans to prioritize.
How the Stars Program is Changing
For years, the Stars program grew more complex, layering administrative, operational, and member experience measures on top of clinical quality. CMS is now changing that approach.
The agency has proposed retiring 12 measures across Star Years 2028 and 2029, including long-standing components such as Appeals Timeliness, Complaints to Medicare, Disenrollment, SNP Care Management, MPF Price Accuracy, and several CAHPS measures, including Customer Service and Rating of Health Care Quality.
CMS has cited that these measures are topped out, low value, or no longer differentiate performance in a meaningful way.
Their removal signals a shift away from administrative oversight and a higher emphasis on clinical outcomes and patient-reported experience within the healthcare system, subsequently pushing health plans to increase performance in areas tied directly to their members’ health status.