Executive Summary

One Transition, Multiple Measures: Protecting Quality Revenue in an
Outcomes-First Era

Protecting Quality Revenue in an
Outcomes-First Era

The CY2027 final rule removed nearly a dozen administrative Star Ratings measures, sharpening CMS’s focus on clinical outcomes and member experience. Transitions of care are one of the highest-leverage places to act: one well-managed transition can lift multiple measures at once and save thousands of dollars for every readmission prevented.

Read our executive summary to learn from health plan executives at Johns Hopkins Health Plans and Elevance Health on how they’re building repeatable workflows with real-time visibility into hospital and SNF stays, so existing teams can intervene before time-critical windows close.

You’ll learn:

• Protecting quality-linked revenue as the Star Ratings measure set shifts
• Why post-acute and SNF stays are underused quality levers
• How one care transition influences multiple quality measures
• Identifying at-risk members and time-critical HEDIS denominators in real time