Skip to main content

White paper

Risk adjustment and Star Ratings success

Discover 5 strategies health plans can implement now to navigate the intersection of risk adjustment and Stars.

In the ever-evolving healthcare landscape, changes are on the horizon for the Centers for Medicare and Medicaid Services (CMS) Star Ratings Quality Measures program. With the 2026 Star Ratings release, CMS will factor risk adjustment metrics into overall Stars performance.

The integration of risk adjustment with quality measures will require health plans to break down silos. These efforts will foster collaboration and leverage data to improve performance. With major shifts underway, achieving and sustaining 4+ stars will require organizations to further evolve an enhanced member-centric approach.

Read this white paper to discover how health plans can take steps now to influence future Star Ratings, including:

  • Breaking down silos to successfully integrate quality, analytics and risk management teams
  • How to better invest in member engagement through coordinated activities
  • Ideas for building health equity through member engagement
  • Ways to effectively close data gaps and improve accuracy to gain credit for performance

Related healthcare insights

View all
Pre-Service: What Consumers Expect Today and in the Future

Infographic

Pre-Service: What Consumers Expect Today and in the Future

Find out what we learned when we asked more than 1,000 people how they feel about the pre-service journey, from provider search to AI use.

Improving ACS Outcomes Through Smarter Evaluation

Article

Navigating the challenges of outpatient evaluation for patients with acute coronary syndrome

Learn how the InterQual level of care team tackled a content development challenge following updated societal guidelines for acute coronary syndrome.

Tech and VBC Models: Enhancing Payer-Provider Partnerships

White paper

Payer-provider collaboration: Improving patient outcomes

Tech and value-based care can improve payer-provider collaboration, reduce admin burden and enhance patient outcomes through data sharing.