Integration of Risk Adjustment in Medicare Star Ratings

This technical report discusses the upcoming changes to the Centers for Medicare and Medicaid Services (CMS) Star Ratings Quality Measures program, particularly the integration of risk adjustment metrics into overall Star performance for the 2026 Star Ratings release. It outlines the evolution of the Star Ratings program since its inception in 2007, highlighting its transition from focusing solely on clinical quality indicators to incorporating a broader range of measurement domains, including member experience, social determinants of health (SDOH), and health equity. The report details the significance of medication adherence measures and their integration into the Star Ratings framework, emphasizing the need for health plans to coordinate efforts across quality, analytics, and risk management teams. It also stresses the importance of member engagement and data accuracy in achieving higher quality care and improving member outcomes. The report concludes with recommendations for health plans to adapt to these changes and enhance their performance in the Star Ratings program.