Stars is entering a period of rapid change — not just a technical update, but a redefinition of how performance is measured and rewarded. Plans that win in this new environment will have built systems that improve experiences and health for every member, not just the reachable few.
This shift is already underway, and the 2027 Proposed Rule makes the message unmistakable:
- Fewer measures
- Higher stakes
- More volatility
- Greater scrutiny of selective targeting
- A Stars program that rewards outcomes across the full population
For plans accustomed to optimizing targeted interventions and timing strategies, the ground is moving — fast.
Here’s what it means for you.
5 key points
1. Measure removals: The floor is about to drop
The Centers for Medicare & Medicaid Services (CMS) proposes removing 12 measures over the next two years — a reduction that will materially alter scoring opportunities and operational priorities. This is less a refinement and more a foundational reset.
The practical effect is:
- Performance compression is likely
- Plans with historically high Stars may see movement downward
CMS is signaling a pivot away from incremental gains toward structural improvements in experience and outcomes.
2. From “Stars gaming” to whole-population performance
For more than a decade, Stars strategy has rewarded operational choreography:
- The right member
- At the right time
- With the right gap
- For the highest yield
Some plans built sophisticated precision engines around this model. CMS noticed.
The new incentives encourage:
- Less reliance on quick-win measures
- Less selective outreach to easy-to-activate populations
- More emphasis on consistent clinical and experiential results
Strategies built on box-checking efficiency will have diminishing returns.
3. Survey measures are becoming dominant — and unpredictable
This may be the most consequential structural change.
Stars 2026: CAHPS + HOS ≈ 1/3 of total points
Stars 2029: CAHPS + HOS ≈ nearly 1/2 of all points
Implications:
- Performance becomes harder to predict
- Early warning signals become less visible
- Improvement cycles become longer and more resource-intensive
- Recovery from poor performance becomes slower
Survey performance requires multi-year investment in:
- Culture
- Relationship-building
- Trust
- Member experience infrastructure
This shift may make Stars less susceptible to gaming, but also more volatile and less controllable, particularly for plans serving diverse populations.
4. Equity: Paused, but not abandoned
CMS paused the Excellence in Health Outcomes for All (EHO4All) reward but retained the Reward Factor, providing short-term stability.
Equity is still embedded in the measures that carry the greatest weight:
- CAHPS and HOS
- Adherence
- Access
- Chronic condition outcomes
5. Depression screening: A multi-step operational challenge
CMS is moving towards outcomes-based measures. The proposed Depression Screening and Follow-Up measure requires multi-step workflows spanning:
- Behavioral health integration
- Member outreach and support
- Scheduling
- Documentation capture
Plans without ready infrastructure will face performance decreases in Part C.
Strategy for 2027–2028: Preparing for a different game
Stars is becoming:
- Less dependent on administrative documentation
- More dependent on clinical and experiential outcomes
- More competitive and more volatile
- More aligned with the Universal Foundation
- More reliant on operational capability and execution
The organizations that outperform will be those that:
- Activate members
- Close disparities
- Coordinate care at scale
- Build durable experience infrastructure
Healthmine exists for this future — not to check boxes, but to move the needle. Our solution already enables payers to scale up and down where needed to meet evolving Stars requirements. Healthmine can already enable plans to:
- More effectively activate all members within a population with targeted messaging, guiding members to their next step. Plans no longer have to send large, generic campaigns that get ignored (and waste dollars).
- Remove barriers to appointment scheduling so members can find and schedule with a PCP without ever having to make a phone call. This AI-supported capability means call center needs are significantly reduced and members get care earlier in the year. See how it works and read our FAQs for more information on effectivness and cost savings.
- Build an analytics and outreach infrastructure that is insulated from Stars changes. Our platform makes it easy to measure, evaluate and send new campaigns — often in 15 minutes or less — so no matter what changes hit, you're ready to start actioning members.
Get in touch to learn more. Contact us today.
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Summary
- CMS is renewing its focus on outcomes across the board. Payers that have perfected the operational choreography of outreaching to a subset of members to selectively improve measure performance will not succeed long-term in Stars.
- The core principles of Stars remains — activate members, improve overall health and work to eliminate disparities, all at scale. But the methods required to meet these goals must evolve or plans will get left behind.
- Even though these changes are proposed, plans should expect that many will be codified in early MY2026. Start evaluating options now and critically assess existing internal resources and where they need to be improved to meet Stars needs. Healthmine's summary of measure changes and next steps checklist can be used to guide these conversations internally.
Mallory has over 15 years of leadership, quality and clinical experience delivering 5-Star quality care for senior populations in managed care plans and assisted living settings. She previously served as the Director of Quality Health Integration at Network Health Plan where she oversaw all regulatory programs and led the plan to achieve 5-Star performance. Mallory is a Registered Nurse and earned her BSN from the University of Wisconsin-Green Bay.
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