Quality Metrics Programs
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CMS’s Medicare Advantage star ratings recalculation is creating immediate financial and competitive implications, with Humana and Clover Health among the plans positioned to benefit from higher quality bonus payments and stronger 2026 positioning—raising renewed payer concerns about star methodology volatility and litigation-driven rating changes (Modern Healthcare). At the delivery-model level, momentum is building around quality infrastructure that can close measurement-to-action gaps: electronic patient-reported outcomes are being positioned as a core symptom-management and value-based oncology tool, while Clarify Health’s acquisition of Loyal Health combines referral intelligence, quality analytics, and patient activation capabilities for health systems managing network leakage and performance risk (Clarify/Loyal transaction.
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