Published on .
Beginning in MY 2026, CMS is introducing sociodemographic status (SDS) risk adjustment into the three cornerstone Part D adherence measures: diabetes, hypertension (RAS antagonists) and statins.
This change reshapes the landscape of Medicare Advantage performance, acknowledging that not all members face the same obstacles on the path to adherence. Age, gender, disability status, and low-income subsidy or dual eligibility (LIS/DE) will all influence how performance is calculated—factors that better reflect the realities of member populations.
At the same time, updates to measure specifications signal that CMS is recalibrating how adherence is measured and rewarded, setting the stage for a more nuanced framework that plans must prepare for now.
A closer look at what’s changing
SDS risk adjustment introduces new performance factors that account for the greater barriers some populations face in staying adherent. CMS is also removing adjustments for inpatient and skilled nursing facility stays while shifting to a continuous enrollment requirement—changes that will alter which members are included in adherence measures and how results are tallied.
Timeline of Changes:
- MY 2026 (2028 Star Ratings): SDS-adjusted adherence measures officially enter the Star Ratings, carrying 1x weighting
- MY 2027 (2029 Star Ratings): SDS-adjusted adherence measures return to 3x weighting
Why this shift raises the stakes
Adherence has always been central to Stars, but SDS risk adjustment makes it even more strategic. For plans serving high proportions of LIS/DE or disabled members, results will now be recalibrated, creating opportunities for fairer comparisons—but also increasing the complexity of performance management.
With the addition of SDS risk adjustment, adherence now functions not only as a central quality driver in Star Ratings, but also as a lever for equity performance—ensuring plans serving higher-risk populations are more fairly measured and rewarded.
The silver lining: adherence as a strategic lever
A sustained focus on adherence is what drives long-term success for health plans. Year-over-year engagement helps members stay on track—and keeps performance strong. In this way, adherence offers plans strategic opportunities, due to:
- Stabilizing health outcomes. Consistent adherence to medications for chronic conditions like diabetes, hypertension and high cholesterol helps keep members healthier, reduces complications and prevents costly deterioration over time.
- Strengthening year-round Stars performance. Even when adherence carries less weight, sustained member compliance supports related quality measures, keeps Stars scores stable and positions plans for a stronger performance when triple weighting returns.
- Building trust and retention. When members feel supported in staying adherent—through personalized outreach, coaching and ongoing engagement—they are more likely to view their plan as a partner in health, deepening loyalty and reducing churn in an increasingly competitive market.
In other words, changes from CMS don’t diminish the importance of adherence within the Stars framework. In fact, maintaining strong adherence during this period is critical—the members who are engaged and adherent now are more likely to stay that way when the triple weighting returns in MY 2027.
Tactics for strengthening adherence
Here’s how MA plans can double down on adherence in today’s MA landscape:
- Invest in digital outreach tools
Platforms like mobile apps, SMS reminders and patient portals help members stay connected to their care schedules and treatment plans. The most effective tools don’t just send reminders—they integrate with provider systems or enable communications that empower members to report side effects, ask questions or obtain refills without barriers. - Deploy predictive analytics
Data-driven insights can flag gaps in medication refills or doctor visits before they occur, triggering timely, targeted interventions that head off costlier downstream care. By combining claims, social determinants of health (SDOH) and engagement data, predictive models also prioritize outreach to members at the highest risk of nonadherence, ensuring resources are deployed when they will have the greatest impact. - Strengthen care coordination
Engage the full care team—providers, pharmacists and other clinical staff—to create a holistic approach to improving adherence. By alerting the team to member risks and needs, plans can ensure gaps are closed quickly, treatment plans are reinforced consistently and members receive timely interventions. - Align incentives with outcomes
Embed adherence performance into provider contracts or plan design, rewarding improved member compliance with benefits, financial incentives, or preferred network placement. For members, offering lower copays, transportation vouchers, or other tangible rewards for consistent adherence can make the value of “staying on track” immediate and real. - Measure and iterate
Track adherence metrics (e.g., proportion of days covered for chronic meds and follow-up appointment rates) alongside cost and utilization data. Plans that regularly share these insights with providers and internal teams create a culture of accountability and improvement. Educating stakeholders on how adherence translates directly into stronger Stars performance, cost containment and member satisfaction helps maintain focus and momentum year-round.
Bottom line
The arrival of SDS-adjusted adherence measures marks more than just accounting changes—it signals a reset in how quality and equity are measured in Medicare Advantage. Sustained member engagement not only stabilizes health outcomes and supports Stars performance but also builds trust and loyalty that outlast temporary weighting shifts.
Plans that double down on adherence now will not only weather the transition but can emerge stronger when adherence returns to triple weighting in MY 2027.
Authored by:
Levi Sanderson, PharmD.
Sr. Director, Clinical Solutions
AdhereHealth
