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The 2027 Final Rule remains the governing rule—and outcomes still matter
For years, Medicare Advantage Star Ratings performance has been heavily influenced by operational execution. As a result, many plans invested in retrospective gap closure and administrative optimization strategies designed to improve measure performance.
But with the 2027 Final Rule, MA plans must now shift their strategy towards outcomes tied to sustained member action over time. And that distinction is critically important.
While recent legal challenges have introduced questions about the future of the Star Ratings program, the requirements outlined in the 2027 Final Rule remain in effect. Until any changes are officially made, health plans must continue preparing for performance under the framework that exists today. Waiting for uncertainty to resolve is not a strategy—and member outcomes cannot be placed on hold.
Why? Because changes ushered in by the Final Rule are focused less on what plans document and more on what members actually do. In other words, the ability to improve members’ behavior is now front-and-center in a successful Stars strategy.
What’s important to note about the 2027 Final Rule?
The most important aspect of the 2027 Final Rule is not simply which measures were removed—it’s what the new and remaining measures require from health plans.
CMS has reduced operational and documentation-heavy measures, while concentrating greater weight into a smaller set of performance indicators, including Part D adherence measures, and the COB and Poly-ACH medication safety measures. In addition, it has added measures that promote screening and care for depression and overall health, and removed the Health Equity Index and EHO4All provisions.
What does this mean for health plans going forward?
First, the remaining measures are increasingly outcomes-driven, with performance determined by the actions members do—or don’t—take. What is now more important than ever is whether members:
- Respond to outreach
- Complete preventive activities
- Fill and take their medications
- Attend doctor appointments
- Follow their recommended treatment plans
Second, despite the removal of health equity-related factors, disparity resolution remains critically important. Social barriers to care directly influence medication adherence, engagement and preventive care participation. As a result, addressing SDOH challenges must remain a core component of any successful Stars strategy.
Despite ongoing debate about the future structure of the Star Ratings program, the direction set forth by CMS today remains clear: Future Star Ratings performance depends heavily on whether plans can influence healthy member behaviors consistently and at scale.
And with fewer measures driving overall performance, the margin for error has become much smaller.
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Medication adherence: a blueprint for Stars success
Medication adherence is one of the clearest examples of the capabilities health plans need to succeed under the current Stars framework.
Unlike many administrative measures of the past, adherence has always depended on member behavior. Plans cannot simply document their way to success. Members must consistently fill prescriptions, take medications as directed and remain engaged in their care over time.
As a result, improving adherence requires many of the same capabilities CMS is increasingly rewarding across the broader Stars program, including:
- Ongoing member engagement
- Identification and resolution of barriers to care
- Personalized communication
- Coordination between plans, providers and pharmacies
And those same capabilities have become increasingly important across the entire Stars landscape.
In many ways, adherence programs have been preparing health plans for this shift all along.
Adherence programs often deliver benefits beyond a single measure
The added bonus of focusing on medication adherence is that it influences far more than the three Part D adherence measures.
When members consistently take medications as prescribed, they are often more engaged in their overall health. They are more likely to maintain relationships with providers, follow treatment plans and participate in preventive care activities.
The result is that adherence can create a ripple effect across multiple areas of performance. Improved adherence supports better clinical outcomes, stronger member engagement, reduced avoidable utilization and a better overall member experience. It can also contribute to greater trust and loyalty among members who feel supported in managing their health.
This is why many organizations view adherence as a strategic investment rather than a standalone quality initiative. Done effectively, it becomes a catalyst for broader performance improvement.
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Improving adherence through sustained behavior change
The challenge with adherence is that it is fundamentally a behavior. Its success rests on repeated actions over time and overcoming any day-to-day challenges that get in the way of completing those actions. And this requires understanding how people make decisions and what motivates them to take action.
Incorporating behavioral science principles helps organizations design engagement strategies that reduce friction, increase motivation and make healthy behaviors easier to maintain, including:
- Improving message timing
- Personalizing communications
- Simplifying decision-making
- Reinforcing positive habits over time
These approaches help health plans move engagement beyond reminders and toward meaningful behavior change—and incorporating them gives plans a competitive advantage.
As outcomes become increasingly tied to member action, behavioral engagement capabilities may become one of the most important differentiators between high-performing plans and those that struggle to improve results.
What will the next generation of Star Ratings programs look like?
Although the future evolution of the Star Ratings may continue to be debated, one principle is clear under the current rules: strategies to improve adherence must be built around continuous engagement rather than episodic intervention. That requires a connected engagement strategy supported by:
- Predictive analytics that identify likely disengagement before gaps occur
- Omnichannel outreach that meets members through their preferred communication channels
- Ongoing barrier identification and resolution
- Reinforcement strategies that encourage healthy habits over time
- Coordination between plans, providers, pharmacies and care management teams
The current goal is not to simply to close gaps, but to create an environment where healthy actions become easier for members to sustain.
Addressing the new era of Stars
The 2027 Final Rule reflects more than a measure update. It signals a broader transformation in how Medicare Advantage performance is evaluated. Today, current updates to the rule remain the governing framework and health plans must continue addressing these accordingly.
For health plans, success depends on the ability to understand member needs, remove barriers to care and encourage medication adherence and healthy actions throughout the year. It’s critical for organizations not to lose sight of the critical importance of adherence in driving member health—now and into the future.
At AdhereHealth, we help health plans navigate the evolving CMS environment. Our solutions improve medication adherence, strengthen engagement and drive the outcomes that matter most in the next generation of Star Ratings. Contact us to learn more!
