The journey to four stars: How one plan transformed its Star Ratings strategy
In today’s Medicare Advantage (MA) landscape, maintaining a high Star Rating is more challenging than ever. Centers for Medicare & Medicaid Services (CMS) regulations continue to evolve, quality measures are shifting, and performance thresholds are rising. As a result, MA plans face mounting pressure to adapt or risk falling behind.
The stakes have never been higher. In the 2022 Star Ratings, 74 Medicare Advantage contracts earned a five-star rating. By 2025, that number had dropped dramatically to just seven. This sharp decline highlights a harsh reality. Achieving and sustaining high performance is now the exception, not the norm.
The 2026 CMS Final Rule and Rate Announcement further underscore the need for adaptability. While codified measure changes were minimal, CMS signaled a shift toward faster and less participatory rulemaking by increasingly relying on interim and direct final rules. These approaches allow changes to take effect more quickly and with limited public input, which reflects the current administration’s focus on faster policy implementation over traditional comment periods.
One regional MA plan has experienced this shift firsthand. After several years of hovering around a three-star rating, the plan dropped to 2.5 stars when the 2023 Star Ratings were released in Fall 2022. Instead of accepting this as the new normal, the organization made a bold decision to rethink its Star Ratings strategy.
The wake-up call
Among its nearly 300,000 total members, the plan serves approximately 14,000 Medicare members, 85% of whom are enrolled in a Dual Eligible Special Needs Plan (D-SNP). The plan has long aimed for a rating between 3.5 and 4 stars, but its performance had fluctuated.
Achieving only a 2.5-star rating in the 2023 Star Ratings was a turning point. It became clear that the plan’s existing strategy, while well-intentioned, lacked the data-driven precision needed to navigate the increasingly complex CMS environment.
Building a multi-year roadmap
Rather than chasing a dramatic one-year turnaround, the plan adopted a multi-year strategy:
- Year 1: Move from 2.5 to 3 stars
- Year 2: Reach 3.5 stars
- Year 3: Achieve 4 stars
This approach allowed the quality team to focus on small strategic wins, such as improving key performance measures and aligning internal stakeholders, without overwhelming team members or setting unrealistic expectations.
The plan also implemented a flexible goal-setting framework. While some measures targeted 4-star performance, others were adjusted to focus on statistical improvement or maintaining gains, depending on the plan’s D-SNP population and eligibility for CMS’s Excellent Health Outcomes for All (EHO4all) incentive.
“What really sets our organization apart is our commitment to data-driven decision-making. Every decision—from frontline operations to executive strategy—starts and ends with data. We don’t guess, we analyze. We don’t wait, we model. And that’s where Cotiviti’s Star Intelligence plays a pivotal role in our success.” — Director of Quality Data Insights and Performance
A smarter, more collaborative approach with Star Intelligence
The plan began leveraging the Star Intelligence platform with support from one of Cotiviti’s dedicated Cotiviti’s Stars analysts, who meet regularly with clients, share best practices, collaboratively identify goals, and prepare personalized work plans. With this support, the client used the tool to analyze historical trends, benchmark performance, and model future scenarios.
One of the most transformative features was the Scenario Modeler, which enabled the team to simulate multiple paths and visualize how incremental changes could impact their Star Rating over time. Incorporating feedback provided directly by the client, this tool became vital part of their planning process and acts as their “what-if engine.”
With the help of Star Intelligence, the plan was also able to leverage predictive cut points, improvement dashboards, and domain-specific detailed views that helped them identify high-impact measures and set realistic, data-informed goals.
“One of the biggest drivers of our Stars success is our partnership with our Stars analyst and the Cotiviti team. We don’t just use Star Intelligence—we use it together. They help us analyze year-to-date, prior year, forecasted rates, and the rates needed for improvement. That collaboration helps us set goals that are both realistic and strategic.” — Director of Quality Data Insights and Performance
Real-time monitoring and collaboration
The plan’s success wasn’t just about having the right tools—it can also be credited to shifting from a reactive mindset to a more proactive and cross-functionally collaborative culture. The team established regular monthly strategic meetings to review performance and adjust priorities. They also created consistent reporting visuals to ensure alignment across departments, from pharmacy to case management to executive leadership.
One example of this proactive approach came when a major pharmacy chain announced closures. The plan’s pharmacy team quickly flagged the potential impact on adherence measures, allowing them to reroute members to alternative pharmacies before performance was affected.
“If I had to call out one best practice that’s really driven our success—it’s the discipline of consistent performance evaluation. It creates space for data-driven decisions, early course correction, and shared accountability across teams.” — Director of Quality Data Insights and Performance
An action plan for Star Ratings success
It’s time to hit the ground running—here’s a specific action plan that MA plans interested in replicating this client’s success can follow.
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Ready to transform your Star Ratings strategy?
Cotiviti’s Star Intelligence platform empowers health plans to:
- Forecast performance using predictive analytics
- Set and adjust realistic, data-driven goals
- Align stakeholders with clear, actionable insights
- Adapt quickly to regulatory and market changes
If your health plan is facing declining ratings, challenges in adapting to shifting CMS requirements, or stagnant strategies, now is the time to act. Read our fact sheet and learn how Star Intelligence can power your next leap forward.
Interested in a personalized demo? Connect with our team and we’ll be in touch as soon as possible to set one up.
