Elevance filed a lawsuit last week against the Department of Health and Human Services and the Centers for Medicare & Medicaid Services, alleging that CMS unlawfully refused to recalculate Elevance's 2026 Medicare Advantage Star Ratings on the same basis that it recently recalculated Clover Health's ratings after a court ruling.
KFF estimates Medicare will spend $13.4 billion on the Medicare Advantage Quality Bonus Program in 2026 amid continued scrutiny of the program.
By reducing administrative burden and redesigning workflows around human needs, it creates space for what matters most: connection between clinicians and patients.
Further change in the Star Ratings program is inevitable, but one thing won’t change: plans that make targeted investments in improving the member experience and clinical outcomes, driven by data, are the most likely to succeed and achieve a higher overall rating.
CMS is proposing major changes to Medicare Advantage Star Ratings, drawing mixed reactions from healthcare leaders.
The pathway for health plans to achieve better Star ratings performance in their MA business depends on creating an ecosystem where providers are supported with the right tools and resources, incentives are properly aligned, and the member experience remains central to all initiatives.
To remain resilient amid the volatility, skilled nursing facilities need to stay on top of what’s impacting operations and consider strategic opportunities. Here are important trends to watch.
What if health plans could identify member decline before an avoidable hospitalization occurs? Real-time clinical visibility into long-stay SNF members uncovers risk earlier and drives better outcomes.
This is a great opportunity to align your strategies with CMS’s evolving framework by refining care models to focus on impact, investing in digital capabilities that support data use, and continuing to build infrastructure that addresses disparities in care.
Medicare Advantage plans can more effectively position themselves for success under an evolving measurement system. Here are three strategic actions health plan leaders should prioritize to enhance 2026 bids to secure stronger Star Rating performance.
Now is the time for health plans to step up and embrace the tools and strategies that will not only meet regulatory demands, but also drive innovation in care delivery.
For 2025, the average star rating for Medicare Advantage Prescription Drug contracts was 3.92, compared to 4.07 for 2024, 4.14 for 2023 and 4.37 for 2022.
Healthcare payments are no longer about transactions. It’s about controlling the revenue cycle. And increasingly, that control is not sitting with ISOs.
Health plans must take a consistent, thoughtful approach to sustaining their business by managing costs without compromising member access to quality healthcare.
Rolling out the ratings nationwide is part of the Trump Administration's larger initiative to inject cost and quality transparency into the healthcare system.