The 3 Biggest Star Takeaways From The 2027 MAPD Rule

Significant headwinds are facing Health Plans when it comes to Stars, per the finalized 2027 MAPD Rule.

If you’re reading this, there is a good chance you’re familiar with those changes, but, in summary, CMS is removing 11 of the ~40 Star measures from the measure set over the next couple of years, while adding in one. CMS projects the impact of these changes to save the Trust Fund $18.6B over 10 years via lower rebate and Quality Bonus Payments resulting from expected lower Star performance.

So the news is not good for health plans, specifically those tasked with maintaining strong Star performance. In all likelihood, we are looking at a world in which 5 Star plans are nearly non-existent, and even 4.5 Star plans become rare.

Digging a little deeper into industry performance, I see 3 key takeaways in the data that will frame how Health Plans should respond.

#1 Health Plan performance will decline in aggregate

The measures that CMS is removing from the system are largely high-performing measures.

7 of the top 11 performing Star measures from 2026 will be retired in the next 2 years

CMS has been transparent and consistent in its treatment of high-performing measures, so it should not come as a shock that several of the highest performing measures are being retired. The net will be worse performance for most plans.

The solution: Health Plans need to pivot back to “traditional” clinical measures of quality management, and the performance levers therein (e.g., Value Based Care). There is no sugar coating it though–removing these measures is a headwind; investing in the remaining measures is critical to staying ahead of the curve, but the curve has shifted down.

#2 Performance in the remaining measures is likely to be more stable

Diving deeper into historic data, a trend emerges looking back at the performance of the measures which are being removed: they tend to be more volatile year over year, when adjusting for cut points.

Consider the exhibit below that examines the volatility of measure Star performance (as measured by the contract average Standard Deviation of Star performance over the last 5 years).

Of the top 15 measures in YoY volatility, 8 are being retired. Contrast that with only 3 being retired in the bottom 22.

Though Star level volatility can be impacted by a variety of factors, one thing appears to be clear: on the whole, the remaining Star measures in the measure set tend to have more YoY stability. That could be viewed as a good or a bad thing, depending on how a plan performs today. What this analysis suggests is that the remaining measure set is more difficult to meaningfully influence (i.e., change Star outcomes) for plans.

The Solution: Prioritize improvement efforts on higher weighted measures more likely to move at the Star level. Cancer screening measures–though important for a variety of reasons–prove to be difficult to meaningfully improve, whereas Readmissions and a number of Part D measures are more likely to move.

#3. Fewer measures = greater contract-level volatility

Your content goes here. Edit or remove this text inline or in the module Content settings. You can also style every aspect of this content in the module Design settings and even apply custom CSS to this text in the module Advanced settings. Your content goes here. Edit or remove this text inline or in the module Content settings. You can also style every aspect of this content in the module Design settings and even apply custom CSS to this text in the module Advanced settings.

“Duh”

Yes, it doesn’t take a rocket scientist to realize that with fewer measures, each measure is worth more in the calculation of Star Rating. Plans are essentially losing (for better or worse) performance diversification.

This could lead to more focused enterprise approaches to Star merely by reducing the number of measures. Fewer meetings! No need to explain to a CEO what MPF price accuracy is! But a hidden burden for Star leaders is the increased volatility that comes with fewer measures. Small swings in the remaining measures will have outsized impacts on overall contract forecasts. And with HOS and CAHPS surveys making up a bigger part of the Star equation, late-cycle forecast changes are sure to persist.

The solution: Star leaders must prepare internal stakeholders for this volatility, particularly from senior leadership, who may be more accustomed to more stable MoM changes in performance. With the increased weight of survey base measures, managing performance expectations later in the cycle will become increasing critical. Plans should be sure to plan internal communications carefully to ensure top-down alignment on emerging performance as HOS/CAHPS data become available.