Cut through the noise, find the signal: Intelligence for serious healthcare leaders
How CMS grades MA plans, what each measure is worth, and where the money moves.
2007
CMS creates the Five-Star Quality Rating System. Initial ratings cover Part D prescription drug plans only (18 measures). Plans receive 1-5 stars based on quality, member satisfaction, and complaints.
2008
Part C (health plan) measures added for the first time. Plans now rated on clinical quality, access, and patient experience. Total measures ~35.
2009
CMS moves to aggregated summary system. Individual measure scores rolled into overall Part C and Part D summary ratings.
2010
Display measures introduced alongside Star Ratings. These are tracked publicly but do not count toward the overall rating — a testing ground for future scored measures.
2011
Overall combined MA-PD score created for the first time, merging Part C and Part D into a single rating. CAHPS/Access measures jump to weight 4.
2012
ACA-mandated Quality Bonus Payments (QBPs) begin. CMS launches QBP Demonstration (3+ star bonus). Improvement measures added at weight 5. Medication adherence measures added at weight 3 — instantly becoming the most impactful Part D measures.
2013
QBP Demonstration continues. Average MA-PD overall rating: 3.7 stars. Weight hierarchy (5/3/4/1) formally established in CY2013 Final Rule.
2014
Final year of QBP Demonstration. 30% of Medicare beneficiaries enrolled in 4+ star plans.
2015
QBP Demonstration ends. Only 4+ star contracts receive bonus payments going forward. Average overall rating: 4.04 stars.
2016
Predetermined 4-star thresholds eliminated. Pure hierarchical clustering adopted for all non-CAHPS measures. Low Performing Icon introduced for contracts at 2.5 or below for 3+ consecutive years.
2017
Categorical Adjustment Index (CAI) implemented for first time. Adjusts for LIS/DE/disabled populations. Modest impact initially.
2018
Hold Harmless provision introduced for improvement measures. Extreme and Uncontrollable Circumstances policy established. Statin Therapy for CVD added.
2019
Medication Reconciliation Post-Discharge added. Relatively stable year.
2020-21
COVID-19 disruption. CMS carries forward 2019 CAHPS data. In-person HEDIS collection suspended. Special scoring rules applied. HOS Physical/Mental Health measures suspended.
2022
Major methodology overhaul: "Better of" methodology, mean resampling in clustering, guardrails (5pp max cut-point change). HOS Physical/Mental Health removed from scoring.
2023
Rheumatoid Arthritis Management retired. Adult BMI Assessment retired. Health equity stratified reporting begins (not yet scored).
2024
Tukey outlier deletion implemented. Cut points shift upward — makes 4+ stars significantly harder. SCAN Health Plan and Elevance Health file lawsuits challenging Tukey methodology. Readmissions weight reset to 1 (new specs).
2025
Readmissions weight increases 1→3. Minor changes. Average MA-PD overall: ~4.17 stars.
2026
MAJOR: CAHPS/Access weights drop 4→2. Physical & Mental Health measures return at weight 1 (new). Two new diabetes measures. Largest structural weight shift since 2012.
2027
Reward Factor eliminated, replaced by Health Equity Index (HEI). MTM Completion Rate retired. Two new opioid/polypharmacy measures. Functional Status returns from display. CMS signals equity-first future.