STAR Gazing (where are the Stars leading?)

What is on the docket for changes going into 2025, 2026 and beyond??

In an earlier article, I posted a listing of the components of the 2025 Star scores (reposted below so you don't need to dig). The only change I can find for SY2026 (i.e. being collected in 2024) is the addition of Kidney Health for Patients with Diabetes, which will have a weight of 1 because it is new. I’ve seen documents stating that Improving/Maintaining Physical Health and Improving/Maintaining Mental Health were both added to this measurement year (MY24/SY26) at a weight of 3x, but I can’t find any confirmation of that.?

OK, on to MY2025/SY2027 and beyond. Let’s just start with a few specific measure changes that are coming up. Care for Older Adults – Functional Status Assessment (COA) will be a Part C measure starting in MY2025 (SY2027) with a weighting of 1x, replacing Care for Older Adults – Pain Assessment. Similarly, Concurrent Use of Opioids and Benzodiazepines (COB) and Polypharmacy Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) are both Part D measures that will come in with a 1x weighting in the same timeframe.

Colorectal Cancer Screening (COL) is having a specification change (lowered age to 45 – 75 from 50 - 75) starting MY2025, so its weighting will be lowered to 1x in SY2027. On the opposite side, Plan All-Cause Readmissions – will have its weight increased from 1x to 3x. A few measures will be retired as well. I already mentioned Care for Older Adults – Pain Assessment, but Medication Reconciliation Post-discharge (MRP), a Part C measure, is being removed. Lastly, MTM Program Completion Rate for Comprehensive Medication Review (CMR) – will be retired to display for MY2025 and MY2026 and will return as a new measure no earlier than MY2027 (SY2029)?

There are also items that have been mentioned as upcoming, but which haven’t been finalized yet. For example, the Transitions of Care measure will continue to have a weight of 1, though it is expected to increase to 3 “in the coming years.” Other measures that they’ve discussed and intend to review for future implementation include “the Initiation and Engagement of Substance Use Disorder Treatment (IET) measure,” “Adult Immunization Status,” “Depression Screening and Follow-Up for Adolescents and Adults” and “Social Need Screening and Intervention.” Contracts are already reporting the latter 3 measures to CMS for the display page.?

A big change that we know about and which was noted earlier is the reduction in the weighting of the Patients’ Experience and Complaints and Access measures from 4x to 2x starting in SY2026 (MY2024). Historically, these measures had a 1.5 weighting and were increased to 2 for SY2021. They were then increased further to 4 with the 2023 Star Ratings, but CMS has now decided to drop them back down to 2 for MY2024/SY2026. This will, of course, raise the relative weight of the HEDIS measures so that they have the greatest overall impact on scores (just over 25%).

Also, as noted earlier, the reward factor for equity (r-factor) is going away and being replaced by the Health Equity Index (HEI). This is going to hurt 4- and 5-star contracts that historically did well with the r-factor. The HEI will summarize data from 2024 and 2025 into a single score to adjust the 2027 star ratings. This factor will be applied to both the summary and overall ratings of contracts that qualify based on an assessment of contract performance on quality measures among enrollees with certain social risk factors (SRFs). The SRFs included in the HEI are receipt of the low income subsidy or being dually eligible for Medicare and Medicaid (LIS/DE), or having a disability. Going forward, as data becomes available through new measures for Social Determinants of Health (SDOH), the agency will consider other SRFs.

In addition, the Hold Harmless provision is being adjusted for the 2026 Star Ratings. Only five-star plans will be allowed to apply this provision, whereas previously it applied to plans with 4 stars or higher. That means contracts that have 4 or 4.5 stars but don’t show statistical improvement will be impacted in their overall star rating. CMS has estimated that this change alone could reduce payments to MA Plans by over $2B.

CMS has proposed removing the guardrails for non-CAHPS measures for 2026, allowing for more significant shifts in cut points exceeding 5%. This is a pretty big deal as evidenced by the consequences of essentially removing them in the initial calculation of the 2024 Stars (refer to the Tukey discussion earlier).

Next, this past final rule codified that all “substantively updated” measures will receive a weight of 1 for the first year they are returned to the Star Ratings. In the second and subsequent years after the measure returns to the Star Ratings after being on the display page with a substantive update, the measure would be assigned the weight associated with its category. This is the same manner in which new measures are handled and will apply starting with the 2025 Star Ratings.

Two final “big picture” things to note. The first is that NCQA is transitioning HEDIS over to digital quality measurement with a final target date of 2030. At that time, plans will be expected to collect and report clinical data on all eligible patients electronically. The first measure moving in this direction is Colorectal Cancer Screening which switches from hybrid data collection (gathering health record documentation from a sampling of patients) to digital for MY2024/SY2026. We should expect other measures to quickly follow and organizations need to be prepared for the new data collection process.

And lastly, because quality metrics aren’t necessarily aligned from one CMS program to the next, CMS is considering a long-term strategy to align the Stars Ratings program with the Universal Foundation for measurement. This Universal Foundation employs a building-block approach, where a core set of quality measures will be applicable across CMS programs, with additional measures tailored to specific populations or settings. This Universal Foundation is meant to apply to private payers as well. This movement has already started. CMS has noted that Part C contracts are already beginning to report additional measures that are part of the Universal Foundation, such as Adult Immunization Status and Depression Screening and Follow-Up for Adolescents and Adults, which will be on the 2026 display page based on MY2024 data.?

You now know everything I do about Stars. I hope you found this summary useful. I am going to combine all of the parts together into one big article so that you can bookmark or save it as a future reference if you'd like. Thank you for taking this journey with me and I greatly appreciate your reactions (likes, etc.) as well as comments. If you know of any further changes coming up that have been announced/suggested or if I got anything wrong, please comment on this article.