Star Ratings Plan Preview: 4 key recommendations

Medicare Advantage (MA) plans are entering a new era of quality reporting. The transition from traditional hybrid HEDIS^® measures to Electronic Clinical Data Systems (ECDS) reporting is accelerating—and many plans may be underestimating its impact on Star Ratings.

Recent Star Ratings data from Plan Preview 2 (PP2) provides a cautionary tale. After the Colorectal Cancer Screening (COL) measure moved to ECDS-only reporting in 2024, its Star Rating cut points dropped across all thresholds by the maximum five points allowed under current guardrails—a clear sign that plan performance suffered when hybrid chart review was removed. As the National Committee for Quality Assurance (NCQA) continues to phase out hybrid measures through 2029, plans must rely solely on ECDS rather than end-of-year chart audits.

Here, as we await publication of the final 2026 Star Ratings, we explain why scores are dropping and offer strategies for MA plans to close out the calendar year with stronger performance.

A perfect storm for lower Star Ratings

MA Star Ratings have been on a downward trend recently, and the ECDS transition threatens to push them further down. The average overall MA-PD Star Rating dropped from 4.37 in 2022 to 4.07 in 2024, and down again to 3.92 in 2025. Only 40% of MA-PD plans earned 4 stars or higher for 2025, down from 68% just two years prior.

There are several factors driving Star averages downward. Most cut points have trended upward year-over-year since the COVID-19 pandemic provisions ended; low-performing plans have exited the market, raising cut points by removing the lower end of the distribution; and CMS has introduced changes to its calculation methodologies such as the Tukey outlier and cut point guardrails. On top of these factors, ECDS conversions add another barrier to improvement. When a high-performing measure drops in performance due to data issues, it drags down the plan’s overall rating.

Not being prepared for the ECDS transition is risky. Plans that fail to thoughtfully approach this transition will see rating drops not because care delivery actually suffered, but because they couldn’t prove the care happened in the new ECDS-only data era. In an environment where Star Ratings are increasingly hard to score well by design, plans can’t afford preventable errors in measure reporting.

Last-quarter push: closing gaps before it’s too late

With Q4 of 2025 upon us, there’s still time to mitigate the impact of the hybrid-to-ECDS change for this calendar year. The Eye Exam for Diabetic Patients (EED) measure is a prime example, since Measurement Year (MY) 2025 is the first year it must be reported with no hybrid supplementation. Plans should make a targeted, organizational push in Q4 to improve their EED rate before December 31. High -impact actions for EED and other measures include:

• Leverage hybrid lift benchmarks: Plans should estimate their hybrid lift from prior years and benchmark current MY 2025 performance against it. If year-to-date results based on administrative data are not exceeding last year’s rates by at least the typical lift that manual chart review used to provide, the plan is already behind. Enrollment growth may further dilute performance, meaning additional year-end outreach or documentation will be needed to catch up. Plans must account for the loss of hybrid boosts on measures shifting to all-digital data.
• Aim higher than MY 2025 PP2 cut points: Plans should set stretch goals approximately four points above the latest PP2 thresholds for key measures such as EED, Controlling High Blood Pressure (CBP), and Glycemic Status Assessment for Diabetes (GSD). Historical trends show many measure-level cut points increased from 2024 to 2026. Aiming several points above the minimum target creates a buffer to offset any further industry-wide performance increases. This cushion helps account for cut point inflation and any data capture gaps.
• Build an EED gap file and geo-target outreach: For EED, plans can create a targeted gap file to drive personalized member outreach. This allows identification of members with open gaps by geography, proximity to network providers, and service availability. Using this data, plans can create geo-targeted outreach cohorts, enabling more precise deployment of mobile retinal screening units or scheduling campaigns in underserved neighborhoods. By aligning member gaps with geographic accessibility, plans maximize the efficiency of outreach resources while addressing social risk factors concerning access to care. Always remember to contact members by their preferred channel to minimize member abrasion in patient experience surveys.
• Partner with vision providers, eye care vendors, and mobile screening vendors. EED success requires collaboration within the community. For instance, plans may host retinal screening days at primary care clinics or send mobile retinal camera vans to convenient locations. Ensure the results make it into a standard electronic format such as claim, EHR entry, or other ECDS-acceptable data to ensure they count.

The transition from hybrid to ECDS reporting is a known shift that directly affects MA Star Ratings, with the fallout already being observed in 2026 Star Ratings preview data. While plans still have limited time in the calendar year to improve performance, adapting to the ECDS era will require long-term investments in integrated and predictive solutions that empower them to determine where to invest their limited resources to make the most impact. This will not only lead to higher quality scores in the future but directly drive improved member outcomes.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).