Quality Metrics & Stars

CMS is signaling a tighter linkage between quality infrastructure and payment risk: the CY 2027 Physician Fee Schedule/MSSP proposals would reshape ACO benchmark and shared-savings economics while putting ACOs on a defined path toward FHIR-based digital quality measurement from 2027–2030, raising the operational premium on data liquidity, measure governance, and forecasting discipline (Wakely MSSP analysis; digital quality roadmap). In Medicare Advantage, Stars remain both economically material and legally contested, with CMS appealing Clover’s star-ratings lawsuit while DOJ enforcement against MA coding inflation underscores that quality, risk adjustment, and compliance strategies are converging into a single enterprise risk domain. NCQA’s approval of person-centered outcome measures for HEDIS MY 2027 further points to a longer-term shift from process-heavy quality programs toward patient-reported and digitally captured outcomes, affecting D-SNPs, C-SNPs, ACOs, and payer-provider contracts.