Don’t let the 2027 Star Ratings shift catch you off guard
Join our risk-free Medicare Advantage pilot to drive measurable clinical results and improve member experience.
April 10, 2026
The Centers for Medicare & Medicaid Services (CMS) released the Final Rule for Contract Year 2027 last week, signaling a clear shift for Medicare Advantage (MA) plans. By retiring numerous Star Ratings measures, CMS is simplifying how members compare plans while refocusing the program on what matters most: member health outcomes and the member experience.
However, administrative simplification is not a reprieve from high performance. While many process-based measures are planned to be removed, the pressure to deliver measurable clinical results is higher than ever.
Star Ratings: focusing on meaningful quality
The most significant changes in the Final Rule center on simplifying and refocusing the measure set of the Star Ratings program to prioritize core clinical care and how members actually interact with the healthcare system.
- Retiring administrative and “topped-out” measures: CMS is removing 11 measures that no longer provide meaningful differentiation, with retirements phased between Measurement Year (MY) 2026 and MY 2027. These removals include the controversial Call Center Foreign Language Interpreter and TTY Availability, SNP Care Management, Plan Makes Timely Decisions about Appeals, and Customer Service (though notably, the questions will remain on the CAHPS survey for monitoring despite their removal from Star Ratings calculation).
- The Health Equity Index pivot: Even though CMS had codified the Health Equity Index (HEI) into rule for MY 2025, it will not be implemented. Instead, CMS is keeping the historical reward factor for Stars Year (SY) 2027, which rewards high-performing plans with low variability.
- New behavioral health focus: To ensure mental health isn’t overlooked, a new measure, Depression Screening and Follow-Up, is being added for the 2029 Star Ratings.
How Cleo supports plans in this refocused Star Ratings landscape
Plans are often overwhelmed by vendor complexity. Layer on significant regulatory requirements and a more sophisticated internal strategy to protect Star Ratings is necessary. At Cleo, we aim to simplify and improve the experience for the member while helping the plan achieve better clinical outcomes.
- Navigating member experience (CAHPS): There is a critical difference between a member being satisfied and having a good experience navigating the healthcare system. Cleo acts as an extension of your internal care team, using specialists for complex conditions like dementia and diabetes to guide members through the system— closing gaps, navigating benefits, and conducting Health Risk Assessments (HRA). This approach improves the member’s experience and moves the needle on CAHPS scores.
- Prospective clinical gap closure (HEDIS): While we help members navigate their benefits, we focus on prospective HEDIS gap closure. We close clinical gaps while we are already engaged with the member. This protects the plan’s Star Ratings while improving health outcomes.
- Frictionless integration: To solve the problem of “app fatigue,” Cleo can be white-labeled and integrated via Single Sign-On (SSO). It feels like a natural part of your plan’s existing tools, ensuring members actually use the benefits you’ve designed.
The CY 2027 Final Rule marks a return to basics, but the stakes for member experience and clinical quality have never been higher. As the highest performing measures in Star Ratings are retired, your plan’s performance will depend almost entirely on core clinical performance and how effectively you navigate members through their healthcare journey.
Is your plan positioned to thrive in this redesigned landscape? Cleo is ready to help you improve your Star Ratings through our specialized navigation and prospective gap-closure model.
