Member engagement is the upstream fix for Star Ratings, risk adjustment, and total cost of care

With the 2027 Star Ratings now released, we’re reviewing the results and what they mean for the market. We’re also in the midst of the last quarter before the program redesign hits, as CMS is taking the program in a different direction starting with the 2027 measurement year, which begins in January. The measure set will narrow to emphasize clinical and experience measures. That shift sharpens a tension most Medicare Advantage plans already live with: Star Ratings, risk adjustment, and total cost of care are treated as three separate goals, with disparate budgets, vendors, and reporting cycles. Yet all three are driven by the same member making decisions about the care they do and don’t seek.

Why root-cause fixes lose to gap closure

If you ask most health plans why they lean on gap-closure vendors instead of tackling the systemic issues behind a low-performing measure, the answer is rarely a lack of awareness. The causes are well understood: inefficient benefit design, network gaps, and provider access challenges. Fixing them requires benefit redesign, contract negotiations, and provider recruitment, all of which take quarters or years. A gap-closure campaign can be live in weeks. When the next quarterly review is closer than the next contract cycle, the fast fix wins, even when everyone involved knows it treats a symptom rather than the root cause.

One lever, three pillars

Member engagement sits underneath all three goals. The care journey starts before a screening, like a colonoscopy, with an engaged member who can easily navigate to preventive care. Completing that colonoscopy closes a Stars gap. The same visit can surface an undocumented diagnosis that improves risk-adjustment accuracy. And catching a condition early, before it leads to an acute inpatient stay, can help keep total cost of care down. With an engaged member, Star Ratings, risk-adjustment accuracy, and total cost of care can improve together.

The member-centric Pager Health℠ approach

At Pager Health, our AI-powered care navigation and wellness solutions are optimized for member engagement. AI engages members across the channels they already use, clinical guardrails ground every recommendation, and licensed clinicians and dedicated health coaches assess member needs. Rather than standing up separate outreach for a Stars gap, a risk-adjustment gap, and a cost-of-care intervention, our engagement programs work from one view of the member, drawing on member preferences, interaction history, and risk factors. That means a single communication can improve more than one result at a time. This member-centric model can replace a stack of point solutions competing for the same member’s attention.

Because experience measures will make up a larger share of a narrower measure set, streamlining your engagement strategy matters more now. Plans that chase three goals with three separate playbooks will keep running into the same trade-offs. Plans that invest in the member relationship can move all three results at once.