DETAILED STAR RATINGS IMPACT CHECKLIST (for Operations, QI, Stars teams)

A. Immediate Priorities (Next 60 - 120 Days)

1. Map the removal of 12 measures

• Identify which of the retiring measures your plan currently underperforms.

• Quantify rating impact once these measures phase out.

• Reallocate staff time toward outcome measures.

2. Prepare for DSF display reporting

• Validate depression screening workflows (annual + per visit).

• Build clinician prompts for required follow-up documentation.

• Align HEDIS DSF logic across vendor, EMR, and chart review processes.

3. Re-model Stars using proposed weighting changes

• Run internal simulations: CAHPS weight 4 → 2 scenario.

• Assess which contracts gain/lose 0.5 - 1.0 stars under new weights.

• Incorporate pharmacy + chronic condition performance as primary levers.

B. Strategic Quality/Stars Priorities for MY 2026 & 2027

1. Clinical Outcome Measures (highest future ROI)

Focus on:

• Diabetes control (A1c poor control)

• Blood pressure control

• Kidney health evaluation

• Medication adherence (triple measure)

• Statin therapy for CVD (modified version)

• Readmission rates

• Controlling Chronic Conditions (multi-condition composite)

2. CAHPS & Member Experience stabilization

Even with reduced weight, CAHPS remains a strong differentiator.
Actions:

• Start-of-year member onboarding campaigns

• Member-friendly benefit clarifiers (reduce confusion → better CAHPS scores)

• Rapid turnaround for grievances & appeals support

• Improving call center first-call resolution (even if retired from scoring)

C. Compliance, Data, & Preview Period Readiness

1. Strengthen HPMS preview review processes

• Build cross-functional “Rapid Review Pods” for Preview 1 & 2

• Validate numerator/denominator inputs

• Reconcile discrepancies with data vendors before ratings lock

2. Update executive dashboards

• Include simulated ratings under both current and proposed methodologies

• Add measure-retirement timelines and DSF monitoring

D. Long-Term Planning (2027–2029 Star Cycle Prep)

Even with HEI delayed, prepare for:

• Stratified quality analytics (dual, LIS, disability, SDOH tagging)

• Equity-enhanced care management

• Culturally responsive communication strategies

• Neighborhood-level risk insights

CMS will return to this space - being ready early positions plans well.