Health plan Star ratings in 2022 are higher than ever due, to a large extent, to the impact of the Covid pandemic. But, we could see falling Stars in ’23 and ’24 when  CMS “guardrails” come back in place.

To prepare, health plans need to consider:

  • CAHPS Surveys (now accounting for 32% of Star ratings) are quadrupling in 2023. These survey results show how a member perceives the quality of care from health plans and providers and the ease with which they were able to access the healthcare system. Moving forward, there will be an increasing focus on ensuring members have exceptional experiences with their health plans.
  • Health Outcomes Survey (HOS) is on hiatus and will not be counted again until 2026 Star ratings. The absence of the HOS measure will  DECREASE its impact on a health plan’s overall rating. This will go from a single weight in 2026 to a triple weight in 2027.
  • Controlling blood pressure will return to 2023 ratings but with a single weight. This measure will increase to a triple weight in 2024, thus INCREASING the impact of this measure on scores.

2024 Star ratings will focus on Care Transitions, including:

  • Plan All-Cause Readmissions – This measure will return to the Star ratings program with a lot of changes to be on the lookout for in ’24.
  • Transitions of Care – New, with 3 new indicators, this measure will look at post-discharge from inpatient facilities.
  • Follow-up after ER visit – Tracking the percentage of adults with multiple high-risk chronic conditions who had a follow-up service within 7 days of their ER visit, this measure will take center stage in ’24.

Health plans saw Star ratings increases this year across many experience measures as well as medication measures.

2023 and 2024 will more accurately reflect CMS’s goal to improve experience AND outcomes, especially for those “high touch” members – hence the focus on “care transitions” and “post-acute follow-up”.

What can health plans do? They can focus on the member journey and the solutions that are necessary to connect with members at each stage in this journey. With the right solutions, health plans will be able to offer highly personalized member experiences that will ultimately affect outcomes and Star ratings.

Want to learn more? Reach out to