Stars in Flux: CMS 2027 Changes

Medicare Advantage organizations are facing a significant policy year as CMS releases updates that signal a recalibration of the Stars program and broader regulatory framework. Recent rule making and guidance point to changes in measurement priorities, simplification efforts, and evolving expectations around quality performance and operational execution. While some updates appear administrative on the surface, they carry implications for how plans evaluate performance, align internal teams, and prepare for future contract years. The episode explores what these federal signals suggest about CMS’s direction and how plans can interpret them within the context of long-term strategy. What do these changes truly mean for 2027 and beyond—and how should leaders respond now? Listen to the full episode to uncover the deeper strategic signals shaping the future of Medicare Advantage.

Host: Medicare Advantage organizations are navigating an unusually dense regulatory year, marked by proposed rules, RFIs, Stars methodology changes, and a federal push toward deregulation. Today, we’re unpacking the proposed rule that was released in December, as well as the Advanced Notice that was released in January. I’m joined by Shelby Jansen, a long-time quality leader who’s spent years helping health plans translate CMS policy into real operational strategy. Shelby, welcome.

Shelby: Thanks for having me. This really is a pivotal moment for Medicare Advantage. What we’re seeing now will shape plan strategy for several years, not just the next contract cycle.

Host: When people hear “a federal push toward deregulation,” that can mean different things. In the Medicare Advantage context, what is CMS actually signaling?

Shelby: At its core, CMS is acknowledging that the regulatory footprint of Medicare, particularly for Medicare Advantage and Part D, has become increasingly complex and costly to administer. Through recent executive direction and formal requests for stakeholder input, the federal government is asking a very direct question: “Which requirements create administrative burden without delivering proportional value to beneficiaries?” CMS wants to actively identify regulations that are redundant, overly complex, administratively burdensome, or misaligned with current care delivery models. In response, CMS issued an RFI, Request for Information, asking stakeholders for input—that would be plans, providers, and vendors.

 
Host: I believe public comments were due just recently in January 2026. Hopefully, Medicare Advantage organizations participated.

Shelby: I agree. This was a great opportunity for plans to weigh in on which Medicare reporting and documentation requirements create the most burden, which quality, audit, and data submission processes are duplicative across Medicare, Medicaid, and commercial markets, what could be automated, streamlined, reduced in frequency, or eliminated altogether, and where compliance costs outweigh clinical or beneficiary value.

 
Host: And it looks like we’re seeing some of this tied into the recently proposed Star measure removal.

 
Shelby: Yes, CMS is proposing to simplify the measures by removing multiple operational, administrative, and topped-out measures. Things like lack of performance variation, small denominators, and administrative burdens that have limited beneficiary value. CMS will not be moving forward with the Health Equity Index and will potentially reinstate the Reward Factor. Again, the shift is away from complexity and is moving toward simpler improvement-based incentives. To layer on to that, the Advance Notice was released this past January, providing reminders for the 2027 Star Ratings and what to strategize for future Star years. CMS reminded us of new or returning measures—all of which are process measures with a weight of 1. These measures include the Colorectal Cancer Screening measure. It comes back returned, respecified, but treated as new. Care for Older Adults, specifically the Functional Status Assessment also treated as new because of the updated specifications.

Beyond additions and removals, CMS is also signaling where Stars is going next. There is continued push toward ECDS reporting and tighter data-quality expectations. We observe potential changes to cut‑point methodology, including exploring percentile‑based cutoffs. Some updates to major measures include, Plan All‑Cause Readmissions, which may soon include denied claims. The Transitions of Care, which may be removed or converted fully to ECDS. And the Diabetes Blood Sugar Controlled measure, shifting fully to ECDS.
What this tells us is that while the program is simplifying on paper, CMS is tightening expectations around data integrity, interoperability, and clinical documentation. It’s fewer measures—but a higher bar for the ones that remain.

Host: Will these measure changes raise the bar for performance?

 
Shelby: Absolutely. When you reduce the number of measures, the remaining ones carry more weight. Performance volatility increases, and operational missteps become more visible.

Host: Another important theme is the shift toward outcomes and experience. How is this theme playing out in the recent proposed rule?

 
Shelby: CMS has been clear that it wants the Stars program to focus more on clinical outcomes and patient-reported experience. CMS is removing process-heavy, topped- out operational measures, increasing the relative impact of outcome-focused measures. That change forces plans to look beyond internal performance and into care delivery itself.

 
Host: That brings us to the one proposed addition to the measure set: Depression Screening and Follow-Up. Why is this significant?

Shelby: Because behavioral health has been underrepresented in the Stars program. This measure assesses whether eligible members are screened for depression using a standardized tool, and most importantly, whether those who screen positive receive follow-up within 30 days. It fills a real gap, but it also introduces new operational complexity. Plans will need strong provider engagement and reliable documentation workflows.

Host: So while the measure set is shrinking, execution becomes more demanding.

Shelby: That’s exactly right. Simplicity at the policy level does not necessarily translate to simplicity at the operational level.

Host: Shelby, you’ve seen the impact of regulatory burden firsthand. Can you share an example of why this matters?

Shelby: Yes, so, earlier in my career, I worked on the care delivery side, responding to overlapping audits, each requesting a slightly different version of the same data on slightly different timelines. Care teams were stretched thin, providers were frustrated, and none of that effort translated into better outcomes for the members. That experience underscored something important for me. Administrative complexity isn’t neutral. It diverts time, attention, and resources away from care delivery.

 
Host: As we wrap up, what should Medicare Advantage leaders be doing now to prepare?

Shelby: Several things: Reassessing Stars performance under the proposed measure set, model the impact of measure removals and weighting changes. Strengthen behavioral health workflows and provider alignment. And finally, align quality strategy with outcomes and member experience, not just compliance. Plans that treat this as a strategic shift, rather than a technical update, will be better positioned long term.

Host: One thing we’ve talked about throughout this episode is simplification. Fewer measures, fewer handoffs, less redundancy. A lot of plans struggle with these themes even outside of Star Ratings and HEDIS performance.

Shelby: That’s absolutely true. I think CMS is actively trying to address this on their end. As CMS simplifies the regulatory framework, it exposes how fragmented many plan’s operating models still are.

In a traditional environment, Stars performance, HEDIS reporting, medical record retrieval, audit response, and quality improvement often live across different systems, and different vendors, and  different teams. That fragmentation creates gaps, delays in data, inconsistencies in reporting, and added administrative effort just to reconcile information.

I think that’s something that we’re actually doing differently from the rest of the industry. HealthEdge is really at the forefront of this. Looking at operations holistically, not just from operational siloes. So yes, we can maximize Stars and HEDIS performance, but it’s a lot more powerful when a plan brings all areas of the business together through a single, integrated operating model. Plans need data that flows across systems. They need platforms that are adaptable to regulatory changes and support for execution. From a Stars perspective, that means plans can continuously monitor performance. From a HEDIS perspective, it improves audit readiness, documentation integrity, and retrieval efficiency. Ultimately, these CMS shifts are going to force plans to get rid of their legacy technology, or, even if they’ve upgraded their technology, many are still using legacy operating models with multiple vendors and handoffs, and delayed data access. I think plans should be paying attention to what these changes mean in the context of Stars and HEDIS, but also what it’s signaling about their broader operating model.

 
Host: This makes sense. Regulatory simplification only delivers value if the underlying operating model can support it. Shelby, thank you for that insight. This conversation makes one thing clear: CMS isn’t just adjusting rules—it’s redefining priorities. For Medicare Advantage organizations, the challenge now is to respond with equal clarity, and simplify where possible, invest where it matters, and stay focused on outcomes that truly reflect quality. If you liked this episode, follow on Apple or Spotify, and share it with your colleagues on LinkedIn.