The CAHPS cut points and state-by-state results are out, and once again, we’ve dug into the publicly available numbers to see what they mean for Medicare Advantage plans heading into the next Star cycle. The topline story is a familiar one: national performance held steady. The more interesting story, once again, is what’s happening underneath it.
National Medicare Advantage CAHPS Trends for Star Year 2027
Nationally, not much moved. The national average scores of eight of the nine CAHPS measures changed by less than half a point year over year, and cut points followed suit, with 69% staying exactly where they were last year. If you’re looking for a single exception, it’s Annual Flu Vaccine, which kept up its multi-year slide, though the pace of decline eased somewhat from last year’s drop. Everything else, including Care Coordination, Getting Needed Care, and Rating of Health Plan, settled into the kind of narrow, unremarkable band that makes for a quiet plan preview period, at least at the national level.
Figure 1a YoY CAHPS National Average Changes
Figure 1b Cut Point Movement Relative To Prior Year
In addition to national averages, CMS publishes state-by-state raw CAHPS performance, and that is a different picture entirely. Louisiana held its position as the top-performing state for the second consecutive year, while New Mexico repeated at the bottom.
Figure 2 Unadjusted State-by-State CAHPS Performance
The more telling detail is what moved. Twelve states saw their relative ranking shift by more than eight spots YoY (e.g., a drop from #2 to #10 or lower). Oklahoma, South Carolina, Georgia, Maryland, and New Jersey posted the sharpest gains. South Dakota, West Virginia, Nebraska, Indiana, Missouri, Idaho, and Rhode Island posted the sharpest declines. The question worth asking? What changed in those markets?
Figure 3 Summary Of States That Changed >8 Spots In The Pareto CAHPS Analysis
How Market Stability May Shape Medicare Advantage Member Experience
Our read: market stability, or the lack of it. Nearly every state that regressed had a documented payer or provider exit in the trailing period, including Aetna dropped Avera Health in South Dakota, Centene left South County in Rhode Island, Humana exited the South Dakota market outright, Aetna pulled out of Idaho, and BCBS of Kansas City left Missouri. When a member’s plan or provider network disappears out from under them, the CAHPS survey picks it up. A member / patient’s experience the first year in a new plan is typically lower than in the subsequent years. Patient experience measures — Care Coordination, Getting Needed Care, Getting Appointments and Care Quickly — showed the widest state-to-state variance of any measure category, well beyond what we saw in plan-perception measures like Rating of the Health Plan.
Why Local Market Context Matters for Medicare Advantage CAHPS
This is where we think the data lends real weight to an argument MedPAC has been making for a while now. In its 2020 report to Congress, MedPAC proposed replacing the current quality bonus program with an MA-VIP model that evaluates plan quality at the local market level rather than the contract level, precisely because so much of what CAHPS is actually measuring is local: provider networks, market disruption, regional care-delivery patterns. Our analysis seems to substantiate this argument. It shows that despite nearly every state having large, multi-state carriers holding significant share, regional variation abounds, and thus that local dynamics are very important in measuring quality.
We’re not here to advocate or prognosticate on one scoring approach or another, but rather to confirm the assertions that MedPAC has been saying.
What Medicare Advantage Plans Should Do Next
But in the here-and-now, health plans operating in volatile markets should treat state-level context as a planning input, not an excuse. For some, that may mean strategic choices about what markets are attractive or difficult to operate in, whereas others may take the lessons learned to inform responses to market volatility with a CAHPS end in mind.
Explore the Full Star Year 2027 CAHPS Analysis
For a deeper view of state-level CAHPS movement, measure-level variation, and the local context behind these results, download Pareto Intelligence’s full Star Year 2027 CAHPS analysis.
To discuss what the findings may mean for your organization, contact our team at contact@paretointel.com.