Why your gap lists won’t survive the new Star Ratings math
The Centers for Medicare & Medicaid Services (CMS) narrowed the Medicare Advantage Star Ratings measure set, removing 11 measures focused on administrative process and adding a clinical measure focused on depression screening beginning with the 2027 measurement year. Each remaining measure will carry more weight. CMS doesn’t set the bar for each measure in advance. Cut points are calculated after the fact, based on how every plan performed that year.
Cut point movement is difficult to predict, especially when you’re setting measure targets for the measurement year, likely over 18 months before they’re released. Between the 2025 and 2026 Star Ratings, the breast cancer screening five-star threshold rose from 82% to 84%, while colorectal cancer screening's fell from 83% to 77%.¹ This unpredictability, which we expect to continue in the 2027 cut points, especially for Healthcare Effectiveness Data and Information Set (HEDIS®) measures, makes it critical that you stay proactive. Optimizing care at a member level can help reduce pressure on last-quarter gap closure, which is a stressful and often low-yield activity.
The problem with working the list
Many health plans respond to this the same way they always have: a separate gap list for each measure. A list for breast cancer screening. A separate list for controlling high blood pressure. Separate outreach, separate vendors, separate cadences, all running at the same time to the same members.
That approach may have worked when the program rewarded administrative consistency as much as clinical outcomes. It may not hold up now that CMS has focused the program around clinical and experience results. Working lists in isolation optimizes for coverage on any single measure, at the cost of losing sight of the person underneath all of them.
A different way to prioritize outreach
The program redesign pushes plans to think and work further upstream, focusing on the member over the gap. You’ll still have measure-level rate targets, but achieving them becomes a byproduct of a member-focused strategy over a gap-focused one. A member with a colorectal screening gap might also have a medication adherence issue and an upcoming annual wellness visit. Three separate outreach streams compete for that member’s attention, without regard for clinical priority, and members may notice the disjointed nature of these communications. A member-focused strategy can help address this and may also have a positive impact on Consumer Assessment of Healthcare Providers and Systems (CAHPS®) scores.
Success despite resource constraints
As your Star Ratings strategy becomes more member-centric and cut points continue to be competitive yet unpredictable, you’ll need to get the most from your care teams. An effective strategy requires the right balance of technology and human interaction with members. You’re managing hundreds of thousands of members across dozens of measures, and you need a way to prioritize outreach automatically, member by member, within a defined budget.
At Pager Health℠, our engagement programs are informed by both clinical priorities and member data, so each member can receive one coordinated outreach plan instead of a separate campaign for every measure. Among opted-in members, gap closure reached 79% for annual wellness visits, alongside 46% for breast cancer screening and 39% for colorectal cancer screening.² One prioritized plan can move several measures at once, not just the gap a standalone campaign happens to target.
CMS has narrowed the measure set and raised the stakes on what’s left. You can adapt by managing your members as individuals, not another gap list, with a member-focused Stars strategy.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Pager Health℠ is a mark of Pager, Inc. All third-party marks are the property of their respective owners.¹CMS, "Medicare 2025 Part C & D Star Ratings Technical Notes," Table K-3; CMS, "Medicare 2026 Part C & D Star Ratings Technical Notes," Table K-3, p. 142 (updated September 25, 2025).
²Based on internal company metrics. Results may vary.