2027 Star Ratings: Turning Priorities into Progress
The 2027 Star Ratings are out, and health plans are looking closely at what contributed to their results. Some will be working to regain lost ground, while others will be focused on maintaining performance. Regardless, both will need staff who can work through medical records carefully, apply the right requirements, and complete reviews on time.
Nationally, the enrollment-weighted average for MA-PD contracts was 3.99 stars, compared with 4.01 in 2026. Of the 508 rated contracts, 188 earned four stars or higher, representing approximately 71% of current MA-PD enrollment. Those results will affect 2028 quality bonus payments. While the national average changed little, it cannot tell an individual plan where its work needs to begin.
Changes reviewers need to understand for Medicare Star Ratings improvement
The 2027 ratings include two new Part D medication safety measures: Concurrent Use of Opioids and Benzodiazepines and Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults, each weighted at one. Care for Older Adults-Functional Status Assessment returned after specification changes, and an updated colorectal cancer screening measure replaced the legacy version.
Care for Older Adults-Pain Assessment and Medication Reconciliation Post-Discharge were retired. The weights for Improving or Maintaining Physical Health and Improving or Maintaining Mental Health increased from one to three.
These changes have practical implications for the people doing the reviews. Instructions need to be updated, and reviewers need an opportunity to work through examples and ask questions. Experience with a measure’s previous requirements can be helpful, but it can also lead to errors if staff continue using criteria that have changed.
The questions that come up during review are often specific:
- Does a reference to a prior screening contain enough information to count?
- Is the outside report available?
- Does the documentation establish when the service occurred?
A reviewer needs to know how to handle each situation and when to send it back for clarification. Otherwise, the same question can be answered differently by several people working on the same assignment.
Where the workload becomes a problem
Plans may have a clear understanding of what needs to be done and still struggle to get through the volume. When staffing is tight, supervisors and experienced reviewers often take on more production themselves. That leaves less time to answer questions, check completed work, and address problems before they affect additional records.
Extra help is most useful when there is enough time to bring people into the process properly. System access, training, sample reviews, and feedback all need attention before a new reviewer is ready to take on a full workload. Waiting until a deadline is close makes that harder for everyone involved.
Clear instructions also make a difference after production begins. Staff should understand what they are reviewing, what information the client expects, and how to document their decisions. When an issue is resolved, that guidance needs to reach the whole team. A correction shared with one reviewer will not prevent the same error elsewhere.
Clients need to know about delays as they happen, too. If records are missing or reviewers cannot access the information they need, the client should hear about it early. That gives the team a chance to resolve the problem while other work continues.
How Can Health Plans Find Review Support for Medicare Star Ratings?
For health plans focused on Medicare Star Ratings improvement, understanding performance gaps is only the first step. Addressing those gaps often requires additional clinical resources to support medical record reviews, coding, and quality abstraction. Health plans can supplement their internal teams by partnering with clinical outsourcing organizations that provide qualified reviewers trained to work within existing processes and quality requirements. This additional capacity helps plans manage review volumes, maintain consistency, and keep quality improvement initiatives moving throughout the year.
How Shearwater Health can help Payers with Medicare Star Ratings improvement
Shearwater Health helps payers address these capacity challenges by providing scalable clinical support within their existing processes. Our teams help health plans strengthen the operational execution behind Medicare Star Ratings improvement through:
- Medical Record Review: Providing additional clinical capacity to manage high volumes of medical records while maintaining quality expectations and deadlines.
- Clinical Coding Support: Reviewing documentation, applying relevant coding guidelines, and identifying cases requiring clarification to support accurate, consistent coding.
- Quality Measure Abstraction: Supporting quality abstraction assignments with reviewers trained on applicable measure specifications and client-specific requirements.
- Scalable Clinical Capacity: Helping health plans manage fluctuating workloads and seasonal demands without overextending internal teams.
- Operational Efficiency: Freeing internal quality teams to focus on complex cases, documentation gaps, and broader Medicare Star Ratings improvement initiatives.
Let’s Talk About What’s Next.
Improving Medicare Star Ratings takes the right strategy, people, and processes. If your team could use additional clinical capacity to turn priorities into progress, contact Shearwater Health to explore how we can help.
