Quality Metrics

CMS quality policy is tightening across both fee-for-service VBC and Medicare Advantage: stakeholder comments on the CY 2027 Physician Fee Schedule/MSSP proposals are pushing CMS to strengthen accountable care participation while reducing reporting burden and improving interoperability, even as draft 2027 MA Star Ratings cutpoints appear harder to achieve—raising performance, revenue, and bid-strategy pressure for plans and providers tied to bonus economics. At the same time, CMS is extending model-based quality accountability into chronic disease and specialty care through the ACCESS technology-enabled chronic care model and the 2027 Ambulatory Specialty Model participant list, signaling a continued shift from volume-based reporting toward measurable outcomes, care coordination, and tech-enabled population management. Medicaid is moving in parallel, with state maternity VBP and Medicaid ACO strategies increasingly using maternal health quality as a test case for tying payment to outcomes and disparities reduction, as reflected in recent analyses of Medicaid ACO maternal health quality and CY 2027 MSSP/PFS stakeholder feedback.