Three strategies quality leaders should focus on following 2025 Star Ratings release
The Stars are out.
The 2025 Star Ratings release from the Centers for Medicare and Medicaid Services (CMS) shows a continued decline in overall quality ratings among MA-PD contracts. In 2022, some 68% of contracts were rated 4 stars or higher; that number stood at 40% with this latest release. Just 7 MA-PD contracts earned a 5-star rating, down from 38 a year ago.
Other trends that stood out:
HOS was a headache: Part C measures derived from the Health Outcomes Survey (HOS) were among the lowest performing measures across the board, with Reducing the Risk of Falling, at 2.6, the worst individual measure overall. All 3 HOS measures performed below the average for Part C measures. With two additional measures from HOS included in 2026 ratings, this is an area of acute need for plans.
Special Needs Plans continue to rise in importance with 6 out of 7 5-star contracts offering dual-eligible benefit packages. Reports indicate that payers are investing heavily in this area ahead of the introduction of the Health Equity Index.
Diabetes Care measures for eye exams and controlling blood sugar both continued downward trends with average Star Ratings decreases for the third straight year. With heavy weightings, underperformance here was a significant blow for plans.
What now?
With Star Ratings tied to the Quality Bonus Program for bonus payments and rewards, Medicare Advantage leaders must remain focused on strategic programs to enhance ratings and elevate program quality to meet the unique needs of members.
To better understand how plans can stay competitive amid market changes and challenges, Bold turned to Jessica Assefa at Ameropia Advisors, a consultancy with deep expertise in Star Ratings that has guided Medicare Advantage and Special Needs contracts to four and five stars on a national scale. Together, we’ve developed key strategies to help plans boost their Star Ratings as we approach the end of the year – and beyond.
Maximizing your Star Ratings: Critical year-end strategies for 2026 success
With the release of the 2025 Star Ratings, some plans may feel disappointed with their results, while others may have exceeded expectations. Regardless of where your plan stands, now is not the time to focus too much on the past.
Star Year 2025 is already baked, and we have a very short window remaining to influence the next set of ratings. Even plans that performed well must continually improve their scores just to maintain their standing in today’s competitive environment.
Looking ahead, here are three key areas to focus on as we approach the end of the year.
1. Close adherence and HEDIS gaps
Adherence and Healthcare Effectiveness Data and Information Set (HEDIS) measures, especially for diabetes and hypertension, are heavily weighted and can significantly influence overall Star Ratings.
Adherence: Target members who are behind on medication fills but still have time to reach 80% compliance. Encouraging a 90-day fill before year-end ensures they remain compliant.
HEDIS: Focus on members who have not yet completed blood pressure or A1C tests, as well as those whose results are just above the 'controlled' threshold. A single additional test can bring them back into compliance, improving scores.
HEDIS Medical Record Retrieval (MRR) Plan: Enhance the MRR process to ensure diligent chart retrieval. Secure internal executive support to address any issues or delays, ensuring the highest completion rate possible for key measures.
2. Maintain member experience outcomes (HOS & CAHPS)
The Health Outcomes Survey (HOS) is in the field through November, and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey will begin in early 2025, with October 1 marking the start of its six-month look-back period. Participation in HOS has declined in recent years, causing many small to mid-sized plans to lack sufficient data needed to report some measures. Plus, low response rates can skew results.
HOS: Encourage HOS survey completion during every member touchpoint and ramp up year-round efforts to prevent falls, encourage physical activity, and address bladder control issues.
For SNP populations, integrating these areas into health risk assessments and ongoing care planning is key.
CAHPS: With the look-back period starting, review member experience feedback and adjust outreach strategies to improve satisfaction in areas like access to care and customer service. Additionally, perform proactive, personalized outreach to members affected by negative 2025 benefit or formulary changes to help improve health plan and drug plan ratings, and ensure members can access necessary medications.
3. Strategic monitoring & planning
Regular review of your Star Ratings Dashboard and work plan is essential to keep strategies aligned with the most impactful goals.
- Stars Dashboard: Stay on top of key metrics by holding regular reviews with your Stars Steering Committee, ensuring that tactics are adjusted in real time to meet end-of-year targets.
By prioritizing these three key areas, Medicare Advantage plans can optimize their performance in the final months of the year, setting the stage for stronger Star Ratings in 2026 and beyond.
How clinical exercise programs help drive these strategies for Star Ratings improvement
In today’s cost-constrained environment, plan leaders looking to put these strategies into action need to remain focused on identifying partners who work to close care gaps and deliver short- and long-term results that improve Stars performance.
Looking ahead, it’s clear that unlocking the value of exercise will be critical for innovative plans focused on 4+ Star Ratings. Members are increasingly making their enrollment decisions based on Stars and benefit offerings, in addition to provider networks and out-of-pocket costs. Bold can help plans stay ahead of the curve and remain first choice in crowded markets, while driving quality improvements across key Star Ratings measures, particularly in underperforming and increasingly important HOS measures, and delivering value for your bottom line.
Ready to learn more about how Bold can help improve Stars and more? Get in touch to find out what sets Bold apart in exercise as preventive care for Medicare members.