Star Ratings are more than numbers—they determine your plan’s financial health, market position, and member loyalty. Every interaction matters, from member experience to clinical outcomes and pharmacy adherence. High ratings lead to bonus payments, marketing leverage, and special enrollment periods, while low ratings risk contract termination.
Beyond the financial impact, Star Ratings influences member retention, acquisition, and broker engagement. High-performing plans are more attractive to providers and consumers, which reinforces trust and credibility.
CMS evaluates performance across multiple domains which include clinical outcomes, member experience, pharmacy adherence, and operational metrics. This underscores that Stars are not solely about clinical care; they reflect the effectiveness of the entire organization.
Star Ratings also provide strategic advantages. The pie chart illustrates the weighting of these domains, with clinical quality and member experience comprising over 70% of the total score. That’s why our strategies today focus on these areas—driving performance through member experience, clinical outcomes, and governance. By aligning efforts across these domains, we help plans not only achieve compliance but also drive sustainable growth and performance in the Stars program.
Improving Stars performance requires a holistic approach: mapping the member journey, focusing on triple-weighted clinical measures, and building governance structures that prioritize quality. Plans must act quickly to address emerging risks, engage providers, and deploy real-time feedback loops to improve CAHPS scores and medication adherence. The reward? Sustained growth and competitive advantage.
BluePeak can help!
BluePeak offers Stars strategy consulting, predictive analytics, and provider engagement tools. We help you implement mock CAHPS simulations and governance frameworks to sustain high performance. Email info@bluepeak.com today to learn how we can help you achieve 4+ Stars and secure your market leadership.
