Why this summer is to do or break for stars notes

Although the plans are still struggling with the important changes from last year to the Center for Medicare and Medicaid Services (CMS) 2025 Star Ratings, more changes are underway. The new administration and Dr. Mehmet Oz, as head of the CMS, promised a stricter examination of insurers and have indicated that more measures are on the horizon. For the Medicare plans, this summer is a pivotal period to adapt to the environment of uncertainty.

The impact of income from 2024 stars notes changes

The notes of 2024 stars have seen significant changes that have had an impact on income from Medicare Advantage plans. The average star rating increased from 4.14 to 4.04, which resulted in a reduction of around $ 1 billion in quality premium payments. The number of five -star plans decreased from 51 in 2023 to 31 in 2024, marking the second consecutive year of drop in star ratings.

The result? Only 42% of the plans received a note of four or more stars, leaving 58% which struggled to reach the four or five -star ranking. This drop in ratings has led to a significant loss of income for many medicare plans, some plans undergoing a reduction in quality premium payments up to 5%.

What’s new this summer?

The health care industry is preparing for potential regulatory changes that may have a significant impact on stars ratings. Plans must quickly face changes such as the increase in the weight of metrics of the results reported by patients and new measures added this year, including a renal health assessment for patients with diabetes, improving or maintaining physical health and improving or maintaining mental health.

This summer is essential to adapt to the new rating rules, expectations and cutting points. The actions that you take now will determine your 2027 Star notes.

Five areas to concentrate

Success in the fall begins in summer. Prepare campaigns, people and partners now before data and information on the efficiency of autumn health care (HEDIS), emergencies on the evaluation of consumers of providers and health systems (CAHPS) and health (HOS).

The plans should focus on five key areas:

Improve members’ commitment to fill the gaps

Optimizing the collaboration of the supplier

Develop emergency plans

Focus on high impact measurements

Regularly examine and adjust strategies

Adapt your efforts for a maximum impact

Concentrate your summer efforts on the measures and members that matter the most. Before launching last -minute awareness and engagement campaigns, confirm your assumptions about performance and objectives in terms of measures, validate suppliers’ ability and pressure preparation for the latest CMS regulatory changes. Zoom into the areas where performance is limited, the gaps usable persist and some CAHPS or HEDIS responses prevent you from achieving objectives.

How to prepare for the unexpected

For a complete control list to guide your efforts from now on in the fall, download the star summer guide and define your plan for the success of the stars.