CMS Likely To Remake Star Ratings!

November 13, 2025

NOTE: This blog is co-published with Lilac Software. See the end of the blog for more information on Lilac’s Stars platform and agentic AI solutions.

As low as Stars are right now, reaching higher in the future could be tougher

A bit of a bombshell from Health Payer Specialist (link at the end of the blog) — well, yes and no.

Officials at the Centers for Medicare and Medicaid Services (CMS) told the publication that changes likely are coming to the Medicare Advantage (MA) and Part D Star rating program. And this could make Star achievement even more difficult in a current environment where ratings are already in the doldrums.

As I have said in the past, CMS and the White House have prominent conservative policy advisors, including from Brian Blase’s Paragon Health Institute. The think tank holds great sway in both the Trump administration and Congress. I have noted Paragon’s work in my discussions on the One Big Beautiful Bill Act (OBBBA). Paragon clearly influenced that bill. While I don’t agree with everything it says, the institute is credible, has good research, and has important points on fraud and sometimes the over-zealous nature of our government programs.

Now, Paragon seems to be influencing MA Stars. Paragon and folks in CMS have concluded that the current rating system is more “check the box” than about true quality. Some of them may want to ultimately remove the added dollars for Stars and if the program stays make it budget-neutral — rewards would be distributed from rate dollars to create winners and losers based on achievement. Initially, easy-to-achieve, “layup” measures (such as certain operational ones) could go away in favor of tougher clinically based measures to ensure progress on chronic conditions and overall quality.

Is this a surprise?

I say this is and is not a bombshell. The Biden administration telegraphed that it wanted to retire a lot of operational measures and adopt more universal foundation measures. That would achieve the goal of moving quality toward more clinical outcomes. The last Biden MA rule was largely not finalized by the Trump administration but it shows the sentiment at CMS. Add Paragon’s influence and this creates momentum for major Stars changes over the next few years. The new Stars approach would match up with Health and Human Services (HHS) Secretary Robert F. Kennedy Jr.’s Make America Healthy Again movement as well as CMS Administrator Dr. Mehmet Oz’s core healthcare philosophies.

The 2026 measures are set, but changes could come in a proposed MA rule for 2027 that would normally be out in late December but might be pushed due to the hiatus of HHS and CMS employees created by the government shutdown.

The impact

I am a believer in continuing the additive nature of Star bonuses (at least for some time), but MA is the only place where extra qualiy bonus dollars exist. Policymakers may come to the conclusion we cannot afford this. I think CMS has done a good job over the years of driving better quality, but the idea that we should get tougher and refocus on the right things is not unreasonable. It is all about how quickly this happens and ensuring the stability of MA while the migration occurs.

So, what does this mean? Plans will need to invest more in Stars. The pivot to true healthcare outcome measures will require quicker and better data collection and analysis, better tracking and forecasting, ongoing strategy refinement, and novel tech-based interventions to close gaps on everyone.

Given where Star ratings are right now, the rollercoaster ride will be perilous but perhaps exciting at the same time.

Lilac Software is here to help you on this Star journey. Its comprehensive Stars platform helps you analyze the freshest data, forecast achievement, develop strategies, and quickly close care gaps. Its agentic AI solutions reduce administrative and staff burden in the outreach and improvement process by managing, analyzing, and even conducting outreach. Go to https://lilacsoftware.com for more information.