The Center for Medicare & Medicaid Services (CMS) recently published two regulatory documents, 2026 Final Rule and the 2026 Rate Announcement within a week. Many of the rules were in line with the proposed rules and advance notice, however there were some changes. We’re diving into the four components of these regulatory updates that health plans should prioritize – and what next steps to take.
4 takeaways and next steps
1. Health Equity Index (HEI) has evolved to Excellent Health Outcomes for All (EHO4all) without any changes to the calculation.
What you should do next:
- Review your HEI reports sent out in December 2024 and confirm if you are eligible for this new reward.
- Focus on identifying and addressing barriers for the low income, dual eligible and disabled population.
- If your contract is not going to be eligible for the reward it is still important to target this population, as these members will require additional support to improve quality of care and close care gaps.
- Download our EHO4all checklist for the six key steps to consider for accomplishing the EHO4all reward.
Healthmine will help you identify a members’ health risks and barriers to care, and help you deliver the right intervention quickly, so you can avoid delayed care or costlier types of care. Our team of expert advisors will dig into the details of your population and outline a performance improvement strategy for your most at-risk and under-engaged populations.
{{form}}
2. ECDS and digital quality measures are here to stay. CMS continues its transition to digital reporting, demanding that plans modernize how they capture and act on member data. The following outlines the current timeline from the National Committee for Quality Assurance (NCQA) to roll out the transition to ECDS that will impact Star Ratings.
What you should do next:
- Review your current digital reporting strategy and identify what will be needed to meet the requirements for upcoming measures.
- Review a breakdown of your HEDIS data sources to identify and address the largest digital data gaps.
Our expert advisors will create a digital quality roadmap to help your plan through the transition to ECDS with a highly-effective, and scalable approach.
3. New measures on display today will impact Stars tomorrow. Now is the time to influence those outcomes.
What to do next:
- Confirm how your performance is compared to the industry and your competitors. Use this time to improve your performance before these measures count towards Stars. The 2025 Display Measure Data were just published by CMS for the public to review. Use this data to see how you are performing compared to competitors in your region and identify top performers to see what policies may need to be implemented.
Healthmine can address 83% of Star measures with our catalog of clinical health actions and increases gap closure by 46%. Our health plan partners are fully equipped to be more successful in the Stars program.
4. 5.06% rate increase for MA plans offers some budget flexibility—but only if you invest wisely in member engagement and data strategies that deliver measurable ROI.
What to do next:
- CMS proposes to simplify the data set for Star Ratings with a focus on more outcome-based measures moving forward. Focus on improving your engagement model to help support more than closing gaps.
In addition to improving quality scores, Healthmine facilitates greater ROI with $336 medical cost savings and $248 increase in risk adjustment revenue per registered member per year.
Lastly, CMS highlighted upcoming validation dates to impact Star Rating 2026 and 2027. Data concerns must be submitted before the preview periods which means that you need to stay on top of reviewing files sent by CMS throughout the year:
- May 30, 2025: Last day to request review of 2024 CTM data
- June 30, 2025: Last day to request review of 2024 appeals data
- May 18, 2026 (SY2027): Deadline for review of Part D Patient Safety data
Healthmine’s team of expert advisors will support you in completing this data validation, allowing you to sustain valuable resources on other priorities.
Get ahead of the curve
Healthmine consultants are available to help build your strategy to get you to 4+ Stars and implement a long-term sustainable engagement strategy.
Reach out to Ana Berridge to get started reaching your performance goals.
.svg)
