Protecting Quality Measures in an Outcomes-First Era

With the CY2027 final rule, CMS removed nearly a dozen Star Ratings measures tied to administrative processes, continuing its shift toward clinical outcomes and member experience. Succeeding in this environment requires plans to identify risk as it emerges and intervene before time-critical windows close.

Transitions of care offer one of the highest-leverage opportunities. A well-executed transition can improve readmissions, medication reconciliation, adherence, member-reported outcomes, and experience of care, while avoiding thousands of dollars in costs for every readmission prevented.