Host: Today, we’re talking with Patricia Graunstadt for a bonus episode inspired by the recent release of the 2025 Star Ratings.

Patricia Graunstadt is an Expert Analyst in the Star Ratings Quality space.  Patricia’s team tracks Star program changes and develops initiative offerings and long-term strategies for reaching and maintaining 4-Star Ratings. Patricia has worked with a variety of clients analyzing all Star measure data and providing accurate projections of plan performance. She holds an Industrial and Operations Engineering degree from the University of Michigan. Welcome Patricia.

Patricia: Hi, thank you so much for having me.

Host: Patricia, as you know, the 2025 Medicare Advantage and Part D Star Ratings came out on October 10, 2024. These ratings are based mostly on 2023 data submitted to CMS. Every year, CMS uses this system to measure the quality of health and drug services that members in Medicare Advantage and Part D plans receive. It's designed to help consumers compare the quality of different plans before they decide to enroll or re-enroll. Could you share some high-level insights into how the industry performed in this latest release?

Patricia: This year’s Star Ratings for Medicare Advantage Part D (MAPD) plans reflect a challenging landscape. Around 40% of plans—representing 209 contracts—earned 4 Stars or higher for their overall ratings, a drop from 44% last year. Despite this, 62% of MAPD members are currently enrolled in plans that will have 4 or more Stars in 2025.

Notably, only 7 MAPD contracts achieved 5 Stars this year, a sharp decrease from the 38 that reached this level in the 2024 Star Year. On the lower end, just one MAPD plan earned a 2 Star rating for 2025, compared to four plans with the same rating last year. The average Star Rating across MAPD plans dropped to 3.92 for 2025, down from 4.07 in 2024, marking the third straight year of declines and the lowest average since 2015. Over a third of plans saw a decline in their Star Ratings during this cycle.

The drop in ratings can largely be attributed to the increased difficulty in achieving high scores. About 71% of the cut points became more stringent, 16% remained the same, and only 13% became easier. The main drivers behind these shifts were the Tukey Outer Fence Outlier removal logic and improved plan performance. The Tukey methodology’s impact will be phased in over the coming years due to the recalculation of Star Year 2024 cut points. This recalibration limited changes in cut points between Star Year 2023 (without Tukey) and Star Year 2024 to 5%, rather than using the more substantial movement seen with the simulated 2023 Tukey cut points.

Most of the clinical, call center, and appeals measure cut points increased in 2025, while CAHPS measures remained mostly stable. One exception was the "Getting Appointments and Care Quickly" measure, which saw a significant increase. Part D adherence measures, on the other hand, stayed relatively stable.

There are also plan characteristics that consistently influence Star Ratings. For example, non-profit organizations tend to earn higher ratings, and established plans with 10 or more years in the program are more likely to achieve 4 Stars or higher compared to newer plans.

This year’s results highlight the increasingly challenging nature of the Star Ratings system and the importance of adapting to these evolving benchmarks.

Host: Let’s talk about changes to Star Ratings that impacted 2025 Star Year performance. You know, what are some details on this program year that may shed light on additional reasons why plans may be seeing changes in performance?

Patricia:   Sure, there were a few key changes in Star Year 2025 that likely impacted plan performance. One of the biggest was the increase in the weight for the Plan All-Cause Readmissions measure under Part C, which jumped from 1 to 3. That’s a significant shift and would have a greater influence on a plan’s overall rating. Another change was the transition of the Breast Cancer Screening measure to using Electronic Clinical Data Systems (ECDS), which could have required plans to adjust their reporting methods. And then, for the CAHPS measures, they introduced web-mode data collection, which changed how member feedback was gathered and might have had an effect on the results. All of these factors combined could have contributed to some of the performance differences we’re seeing this year.

Host: Based on what you’re seeing, where do you see the industry headed? What do you anticipate in the years to come?

Patricia:  There are some big changes ahead for the Star Ratings program, so it’s crucial for health plans to stay flexible and ready to adapt. For Star Year 2026, we’re seeing several notable updates. First, the Kidney Health Evaluation for Patients with Diabetes will no longer be just a display measure—it’s officially joining the Star Ratings with a weight of 1. Colorectal Cancer Screening is also transitioning to Electronic Clinical Data Systems (ECDS) and will no longer be a hybrid measure, which will impact how it’s reported. Additionally, the two follow-up HOS measures—Improving/Maintaining Mental Health and Improving/Maintaining Physical Health—are coming back with a weight of 1 after a significant specification update. Another big change is that the CAHPS and Administrative Patient Experience weights are dropping from 4 to 2, which means CAHPS will represent 22% of the Star Ratings program, down from 32% in Star Year 2025. This shift helps balance the program across a broader range of measures.

Looking ahead to Star Year 2027, there are even more changes on the horizon. The same HOS measures will increase to a weight of 3, giving them much more influence on overall scores. The current Reward Factor will be replaced by a new Health Equity Index, which will be based on data collected in Star Years 2026 and 2027. There are also two new pharmacy measures coming into play: Concurrent Use of Opioids and Benzodiazepines, and Polypharmacy: Use of Anticholinergic Medications in Older Adults, each carrying a weight of 1. Meanwhile, the stand-alone Medication Reconciliation Post Discharge measure will be retired, and the MTM Completion Rate for CMR will move to the display page for 2027 and 2028, set to re-enter the Star Ratings in 2029.

But even with these future changes in mind, it’s important not to lose focus on what’s happening right now. There’s still a lot that health plans can do in the fourth quarter to make an impact on their 2026 Star Ratings. Plans need a well-rounded Stars strategy that’s flexible enough to keep up with these evolving requirements while also maintaining a strong focus on stability and continuous improvement. Staying ahead of the curve is going to be crucial for success.

Host: Patricia, thank you for sharing your insights on the recent changes and what plans need to focus on for continued progress in Star Ratings. To all our listeners, if you liked this episode, share it on LinkedIn with your colleagues, follow and leave a review on Apple Podcast or Spotify.