As we wrap up the year, we’re spotlighting the most important takeaways from 2025, included in blogs that health plan leaders read the most. Below are the critical insights from each, and links to read the full article if you’re ready to go deeper.
1. 2027 Proposed Rule revisits outcomes-based bonus payments
Star Ratings has become a game of refined operational choreography — strategically focusing on subsets of their populations with certain care gaps, all designed to achieve quick wins that maximize rewards. CMS wants to change that. The proposed changes would incentivize plans that improve outcomes across the board, rather than the easy-to-activate members and measures. If the proposed rules are codified, CAHPS and HOS will become increasingly important and plans won’t have the “box checking” admin measures to lean on.
Read the full blog and download a checklist of next steps →
2. 2026 Star Ratings: What the final results reveal
In our “Stars Year 2026 Report: Highlights and the Path Forward,” we walk through the final 2026 Star Ratings and what’s ahead. While 45% of plans maintained their Star level, 29% dropped at least half a star, and 26% improved by that same margin. We highlight that plan size and geography weren’t the deciding factors — dedication and strategic investment were. High-performing measures included diabetes eye exams, blood sugar control and medication review, underscoring the importance of focusing efforts where they matter. Moving into 2027, key changes like the replacement of the Reward Factor with EHO4All and shifts to ECDS reporting will require health plans to realign their dashboards, set new goals, and double down on data-driven quality strategies.
3. Pitfalls to avoid in your member rewards program
We call out three common mistakes plans make — and how to solve them. First, generic, one-size-fits-all messaging wastes your budget and fails to activate the people who actually need motivation. Second, risk and quality teams often run separate reward strategies, leading to misaligned incentives and confusion. Third, using third-party reward fulfillment can frustrate members when redemptions take too long — undermining trust. The fix? Use a coordinated rewards strategy, personalized outreach and rapid fulfillment to keep members engaged and closing gaps.
4. AI-powered scheduling removes barriers to care and saves money
This blog explains how complexity in scheduling contributes to missed care — and how AI can solve that. By integrating an AI agent into our engagement platform, we help members schedule appointments based on their preferences (provider, language, convenience) without wrestling with hold times or confusing call centers. This isn’t just a member experience win — it leads to better preventive care, faster gap closure, and real cost savings. The result: more in-office visits, better risk capture and fewer downstream complications.
Read the full blog →
5. How siloed risk and quality teams are a liability — and what to do about it
Uncoordinated risk and quality teams hurt member engagement and performance. When both operate in isolation, members often receive redundant or conflicting messages. That leads to fatigue, confusion and lost opportunities. Our solution? Unify outreach via a single engagement platform, align teams around shared metrics, and use omnichannel communication with behavioral science to guide members through prioritized care journeys. The outcomes speak for themselves: more provider visits, better gap closure, reduced churn and more efficient use of your engagement budget.
6. How we’re different from other engagement vendors
Understand our four differentiators: speed, omnichannel engagement, rewards and real-time reporting. Plans using our Quality Relationship Management™ (QRM®) platform have seen a 52% increase in provider visits and clinical gap closure, $336 in medical cost savings per member and a 13.8x ROI within three years. Unlike many engagement vendors, we deploy campaigns in minutes (not weeks), align outreach across channels, coordinate rewards strategy, and surface member-level insights via live dashboards.
7. Bid prep: How Healthmine’s engagement tools are MLR-eligible expenses
Learn how quality improvement engagement isn’t just good for care — it’s strategically aligned with CMS rules. Our tools — including HRA campaigns, incentive programs, wellness education, and analytics — meet CMS definitions for allowable MLR expenses. That means when plans invest in engagement via Healthmine, they’re not just improving outcomes; they’re optimizing their medical-loss ratio write-offs. It’s a smart, compliant way to drive quality and financial performance in tandem.
Read the full blog →
Why These Insights Matter for 2026
These seven takeaways capture where the health plans and CMS are heading — and where you need to be to succeed. Whether you're thinking about Star Ratings strategies, rewards design, appointment access, team alignment, engagement ROI, or financial optimization, these takeaways reflect real outcomes and actionable strategies.
Summary
- The Star Ratings landscape is shifting. Plans are being challenged to move beyond “check-the-box” measures. Success now hinges on unified data strategies, CAHPS and HOS performance, and improving clinical outcomes across the membership, instead of a subset of members.
- Whether it’s AI-powered scheduling, coordinated rewards programs, or eliminating silos between risk and quality teams, the throughline is clear: personalized, unified outreach drives higher activation, better gap closure and meaningful cost savings.
- Vendor selection is a difficult process to navigate within a health plan. Healthmine has defined how payers can build sustainable financial models by incorporating Quality Relationship Management™ (QRM®) into their bids and ensuring consistently growing ROI for our clients.
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