Why a daily member relationship is the one strategy that holds up no matter how Star Ratings change
For years, the industry has treated the Star Ratings measure set as fixed. The last month should end that assumption. In Clover Health v. HHS, a federal court found that CMS improperly included certain measures in calculating Clover's rating and ordered a recalculation. On June 17th, CMS told all Medicare Advantage organizations it would voluntarily recalculate 2027 Quality Bonus Payment ratings for certain contracts in response, viewable now in HPMS.
The mechanics are narrow and backward-looking, and CMS was explicit that this recalculation does not set policy for 2027 and beyond. We won't tell you what it predicts. But the signal underneath it is hard to miss: if the measures and weights that determine your rating can be challenged and changed, then no single measure is as fixed as plans have built their strategies around.
For plan leaders staring down bid deadlines, that's not an academic point. It's a planning problem.
What doesn't move
Quality strategy has been organized for years around a long list of individual process measures. Rulings and recalculations like these are a reminder that the list, and the weights on it, can move. What doesn't move is where the score actually comes from: the daily actions of your members. Part C outcomes, CAHPS, and HOS all rise and fall on whether members do the things that keep their conditions controlled and feel cared for in the process.
Predicting a score isn't the same as changing it
Plenty of tools can tell you where your CAHPS or HOS numbers are likely to land. Far fewer can move them. A prediction is a snapshot. Improvement requires a member to act, and to keep acting. That only happens when the relationship is consistent, positive, and present in daily life, not when a measure exists on a spreadsheet.
Consistent daily member behavior is the intervention
Members disengage because the system has never given them a steady, positive reason to stay engaged. Close that gap and the measures take care of themselves: care gap closure across CBP, GSD, EED, KED, BCS, and COL, stronger chronic condition control, and the trust that shows up in CAHPS and HOS.
Wellth: a daily relationship built for every outcome
Wellth builds a daily relationship between your plan and every member. Members snap a photo, just like sending a text, to document the daily actions that drive quality and cost outcomes. Our platform turns those touch points into habits, and those habits into measurable results: 90% average care plan compliance, a 42% average reduction in inpatient utilization, and NPS scores above 70.
Whatever the final framework looks like, the move is the same. Don't wait for certainty that may not arrive before your next deadline. Invest in the daily relationship that drives every outcome you're measured on, because it's the one variable that pays off in every scenario.
Get an expert opinion on what this moment means for you
We're funding ten Star Ratings office hours with an independent industry expert to talk through what this moment means for your plan and your members. No pitch, no charge, just an expert advisor to think it through with one on one. The first 10 quality leaders to claim a session will get time with one of our Star Ratings advisors. Request yours here.
- References
- Crowell & Moring, "Clover Insurance v. HHS: SD of Georgia Holds 20 Star Ratings Measures Unlawful" — https://www.crowell.com/en/ins...
- Mintz, "Clover Health Decision Raises Significant Questions for CMS Star Ratings Framework" — https://www.mintz.com/insights...
- Healthcare Dive, "CMS recalculates Medicare Advantage stars after Clover lawsuit loss, but not a freebie for plans" — https://www.healthcaredive.com...
- Healthcare Finance News, "CMS is voluntarily recalculating 2027 MA star ratings bonus payments" — https://www.healthcarefinancen...
- The Healthcare Labyrinth, "Calling All Plans: CMS Recalculates Some SY 2026 Ratings" — https://www.healthcarelabyrint...
- Clover Health 8-K (SEC filing) — https://www.stocktitan.net/sec...
- Wellth outcomes data — wellthapp.com
