When we were presented with the opportunity to accelerate that vision by combining with an organization with highly aligned values, vision and products, we decided it was too good topass up up. Today, we are excited to announce that Lilac has been acquired by Medisolv. 

Combining Medisolv’s industry-leading clinical quality intelligence platform with Lilac’s AI-driven predictive analytics and MA Stars expertise allows us to rapidly develop a new generation of technology to empower health plans and providers to turn quality data into action.

The Problem: Quality Data Exists, But Action Is Hard

Healthcare organizations today have access to more quality data than ever before. Clinical records, claims data, and performance reports are widely available across programs such as:

• Medicare Advantage Stars
• MSSP and ACO programs
• HEDIS and other quality measures
• Emerging patient-reported outcome measures

Yet most organizations still struggle to translate this data into better health outcomes and better business performance. 

The challenge starts with fragmented clinical and claims data spread across multiple systems, making it difficult to form a unified view of performance. At the same time, they lack predictive insight into future quality outcomes and face challenges determining which patient care gaps will have the greatest impact. Even when those gaps are identified, operational barriers make it difficult to engage patients effectively at scale.

The Opportunity: Connecting Clinical Intelligence with AI-Driven Analytics

By combining Medisolv and Lilac, we’re working to address a critical gap in value-based care infrastructure. Medisolv brings deep expertise in clinical quality measurement and regulatory reporting, supporting more than 100,000 providers nationwide.

Lilac contributes predictive analytics, claims-based performance insights, and AI-driven patient engagement technology designed to help organizations proactively close care gaps.

Together, these capabilities create a platform that helps healthcare organizations:

• Predict quality performance earlier:  AI-driven analytics identify emerging risks across measures like Stars and HEDIS before performance gaps widen.
• Connect clinical and claims insights: Combining these two perspectives creates a more complete picture of patient care and quality performance.
• Scale member/patient engagement: AI-enabled outreach helps organizations engage patients efficiently, collect important quality data, and close care gaps.
• Reduce administrative burden: Automating quality intelligence and outreach allows teams to spend less time assembling reports and more time improving care.

Why This Matters 

For health plans, ACOs, and risk-bearing provider groups, success increasingly depends on managing performance across multiple value-based programs simultaneously.

That requires technology capable of:

• Identifying high impact care gaps earlier in the year
• Coordinating outreach across large patient populations
• Aligning clinical and financial performance metrics
• Enabling operational teams to deliver better health outcomes more efficiently

The Medisolv<>Lilac combination is designed to address exactly these needs.

By integrating clinical quality intelligence with predictive analytics and AI-driven workflows, healthcare organizations can move from retrospective reporting to proactive performance improvement.

Looking Ahead

At Lilac, our mission has always been to help healthcare organizations turn data into action using AI.

By joining forces with Medisolv, an organization already trusted by more than 1,800 healthcare organizations and 100,000+ providers nationwide, we can accelerate the development of new capabilities that help health plans and providers:

• Close care gaps faster
• Engage patients more effectively
• Improve quality outcomes
• Succeed in increasingly complex value-based payment models
• Reducing the cost of care while driving quality improvement

Neetu Rajpal, CEO and Co-Founder of Lilac: “We founded Lilac to help healthcare organizations turn data into action through AI. As payers and providers push toward value-based care, we’re excited to bring our predictive analytics and AI capabilities together with Medisolv’s trusted leadership in clinical quality management. By combining our claims-based insights with Medisolv’s deep clinical expertise, we can accelerate the development of a new generation of agentic AI-driven solutions that help healthcare organizations not only measure performance but actively improve it.”

David Lucey, Jr., CEO of Medisolv:  “This acquisition marks an important milestone in Medisolv’s evolution. For decades, our mission has been to help healthcare organizations understand and improve their quality performance. With Lilac, we expand that mission from measurement to prediction to impact. By combining clinical quality data, claims analytics, and agentic AI, we are building a platform that not only reports on performance but actively helps providers and payers close gaps in care, reduce administrative burden, and succeed in value-based payment models.”

Reach out here to start a conversation about how the combined Lilac<>Medisolv can help you.

About Medisolv, Inc.

Medisolv is a national leader in healthcare quality data management, helping hospitals, health systems, providers, and ACOs deliver safer, higher-quality care. For more than 25 years, Medisolv has supported the full quality journey across inpatient, outpatient, and ACO programs through its all-in-one quality improvement solution, ENCOR, which supports more than 500 national quality and safety measures required by CMS, The Joint Commission, state agencies, and private payers. Medisolv’s solutions span data abstraction, digital measures, registry reporting, performance analytics, and trusted advisory services. Trusted by more than 1,800 healthcare organizations and 100,000+ providers nationwide, Medisolv is recognized with Best in KLAS, Black Book, and HIMSS Policy Changemaker awards for excellence in client satisfaction and leadership in digital quality measurement. For more information about Medisolv, please visit www.medisolv.com.

The post Lilac Joining Forces with Medisolv – Accelerating AI Powered Stars and Quality Performance for Health Plans and Providers appeared first on Lilac Software.

Anyone working in or following Medicare Advantage (MA) knows this is not a simple moment for the program. We already have a sweeping proposed MA and Part D rule for 2027, an active transition to electronic measures (ECDS), and CMS’s longer term push toward a Universal Foundation across quality programs. All of that is happening at once.

Against that backdrop, it’s easy to overlook the quieter but critical details embedded in the annual Advance Notice. Much of the document is rate-focused (and yes, I still read that part), but buried in the text are the pieces that function as the operating manual for Stars: calendars, deadlines, measure additions and removals, weighting shifts, and implementation guidance that will shape plan performance for years. Generally speaking, Star changes need to be published in rules, but the notices and announcements serve as the implementation guide for plans.

Below is a focused walk-through of the Stars-related highlights from the proposed 2027 Advance Notice, which will be finalized in the April Final Announcement.

Deadlines/Calendar Reminders for Star Year (SY) 2027 and SY 2028

For Measure Year (MY) 2025 / SY 2027, plans should note:

• March 31, 2026 – Complaints Tracking Module (CTM) data review requests
• May 18, 2026 – Part D drug measure administrative data review requests
• June 30, 2026 – Part C appeals data review requests

For MY 2026 / SY 2028:

• March 31, 2027 – CTM data review requests
• May 18, 2027 – Part D drug measure administrative data review requests

One important reminder here: these review deadlines arrive before final PDE and appeals data are complete and before what many think of as the “official” closeout at the end of June. Practically speaking, plans need to be reviewing data early and aggressively, particularly for discrepancies that may not fully surface until after submission windows close.

Measure Additions, Removals and Changes for MY 2025 / SY 2027

CMS proposes six new or updated measures for SY 2027, including:

• New Measure: Colorectal Cancer Screening – Being respecified and treated as a new measure, with an expanded age band. Guardrails will not apply, and the impact at the half-Star cut point could be meaningful.
• New Measure: Care for Older Adults – Functional Status Assessment (COA-FS) 
• New Measure: Concurrent Use of Opioids and Benzodiazepines (COB)
• New Measure: Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (PolyACH)
• Changed Measure: Statin Use for Persons with Diabetes (SUPD) – Added a statin tolerance exclusion 
• Changed Measure: Diabetes Care — Eye Exam (EED) – Removal of the chart review option 

Three measures will be removed beginning in SY 2027:

• Care for Older Adults – Pain Assessment
• Medication Reconciliation Post-Discharge
• MTM Program Completion Rate for CMR (NOTE: with a planned return in SY 2029)

Weighting changes for SY 2027:

• Improving or Maintaining Physical Health (IMPH) moving from 1x to 3x weight
• Improving or Maintaining Mental Health (IMMH) moving from 1x to 3x weight
• Health Outcome Survey (HOS) moving from 1x to 3x weight

Other Notable SY 2027 Updates

• Part C Appeals: CMS will use Part C reporting data to validate the completeness of IRE data used in the appeals timeliness measures.
• CAI methodology: For the first two years after contract consolidation, LIS/Dual and Disabled percentages will be calculated using combined December enrollment across merged contracts.
• EHO4all: While still reflected in measure tables, the proposed rule would retroactively remove EHO4all for SY 2027 while retaining the Reward Factor.

Disasters in Play for SY 2027

CMS identifies two disasters affecting SY 2027:

• January 2025 Los Angeles Wildfires
• July 2025 Texas storms and flooding

The LA wildfires are notable in that they affect both SY 2026 and SY 2027 CAHPS results, with plans receiving the better of the two years. In some cases, this effectively pulls forward SY 2025 measure-level results.

Looking Ahead: SY 2028 and Beyond

Several forward-looking changes deserve attention:

• Statin Therapy for Patients with Cardiovascular Disease (SPC) is undergoing substantive changes and ECDS conversion, with proposals ranging from display-only status to full removal.
• Medication adherence measures will incorporate risk adjustment and temporarily drop to 1x weight.
• Call Center measures are proposed for elimination in SY 2028.

Beyond that, CMS and NCQA are signaling continued evolution for Readmissions, Transitions of Care, Diabetes Blood Sugar Control, and multiple display measures—many tied to an eventual shift to ECDS-only reporting by MY 2029.

A Word on Cut Points

Finally, CMS continues to explore simplifications to the Star Ratings methodology, including the possible use of percentile-based cut points instead of clustering for non-CAHPS measures. This could improve transparency and predictability but it also introduces the possibility that CMS more explicitly “sets” the distribution of Star outcomes.

What This Means for MA Plans

The Stars program is not just changing. It is layering change upon change. Plans that understand the Advance Notice offers the operational insights that light the path to a 4+ Star performance are the ones that are best positioned to succeed. This is no small task given the volume, complexity and nuance of how CMS administers Stars. At Lilac, we closely track all CMS communications, including the Advance Notice, to help plans quickly and efficiently translate Star program changes into aligned strategy and tactics. 

This article is published in collaboration with The Healthcare Labyrinth. For a more detailed review of the 2027 Advanced Notice, check out the accompanying article on the HCL blog.

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Lilac’s Stars Management platform helps plans navigate these types of major changes to Stars.  We have the data models and analytics to easily understand the strategic implications of Stars program changes and agentic AI tools to make a plan’s member engagement in support of Stars more efficient and impactful.

 Reach out here to start a conversation with the Lilac team about how we can help your plan.

The post Planning for Stars in a Crowded Reform Cycle: Take Aways from the 2027 Advance Notice appeared first on Lilac Software.

But hold on.

Even if the Star measure goes away, SNP audits and regulatory requirements do not. HRAs remain the foundation of SNP care management, quality oversight, and audit compliance.

Back in September, Lilac’s partner site The Healthcare Labyrinth published detailed blogs on explosive SNP enrollment growth and tightening audit trends (The Meteoric Growth of SNP Plans (SNPs) and Special Need Plans Audits Complex and Growing). Those dynamics make HRAs more important even with the removal of the aforementioned Star measure.

A quick SNP history lesson

Not long ago, SNPs were nearly phased out. CMS viewed them as marketing vehicles rather than clinically robust programs, kept alive only by temporary congressional extensions. But CMS eventually recognized their potential, especially for dual eligibles, who account for roughly 80% of SNP enrollment through D-SNPs and drive disproportionately high costs and poor outcomes.

CMS pivoted. SNPs were permanently reauthorized, and a much stricter clinical and audit framework followed. Partnering with NCQA, CMS raised expectations for Models of Care (MOCs) and dramatically strengthened audit protocols.

Early audits focused on process: Were HRAs completed? Were care plans issued?
Today’s audits go much deeper. They go beyond “box ticking” exercises and evaluate clinical delivery, care coordination, outcomes, and documentation.

Chronic Special Needs Plans (C-SNPs) and Institutional Special Needs Plans (I-SNPs) also include many dual-eligible members, with most non–D-SNP enrollment now in C-SNPs. Plans have invested aggressively in C-SNP growth for 2025–2026, prompting CMS to propose reforms that would align C-SNP requirements more closely with D-SNPs. As CMS signaled in its 2027 MA and Part D RFI, new Medicaid contracting and oversight requirements may be coming. In short, CMS is wary of repeating past “growth-first” SNP mistakes.

Why HRAs still deeply matter

HRAs remain the linchpin of SNP compliance and care delivery. As enrollment surges, many plans struggle to complete both:

      1)    Initial HRAs (required to be conducted within 90 days of a member’s enrollment)

     2)    Annual reassessments (required at least every 365 days thereafter)

Poor HRA performance can sink an audit but the real damage is downstream:

• Individualized Care Plans (ICPs) may not be effective or issued timely enough

• Preventive care plans for unreachable members may be missing

• Interdisciplinary Care Teams (ICTs) may be incomplete or misaligned

• Goals, interventions, and progress may be inadequately documented

• Interim assessments during care transitions or risk changes may not occur

• Member self-management and engagement may be limited

• Care may not be coordinated across the broader clinical enterprise

Without HRAs, plans lack the clinical backbone to manage, measure, and improve outcomes.

The operational reality and the way forward

HRAs are table stakes, but executing them at scale is increasingly difficult. Reaching a member may require up to ten outreach attempts across days and times. Multiply that by rapidly growing SNP enrollment, and the administrative burden becomes enormous.

This is where technology, and particularly agentic AI, can make a meaningful difference.

Used thoughtfully, agentic AI can:

• Conduct outreach and complete all or portions of HRAs

• Reduce administrative load on clinical teams

• Streamline information gathering and data flows for care plans, ICT activities, and goal tracking

• Detect changing risks and trigger interim assessments

• Serve as a bridge between SNP care teams and the broader clinical enterprise

With nurse care managers scarce, overloaded, and increasingly expensive, plans must rethink how work gets done. The requirements are evolving, enrollment is accelerating, and expectations are rising.

HRAs may be losing their Star measure label but they remain mission critical. Plans that invest now in scalable, tech-enabled approaches will be far better positioned to meet both clinical and compliance demands in the years ahead.

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Lilac has built a suite of agentic AI solutions enabling cost-effective, high quality member engagement. We have a module dedicated to supporting a health plan’s HRA program. Learn more at our Agentic AI Solutions page or reach out here to start a conversation about how we might be able to help you and your plan.

The post The SNP Care Management Measure Is Going Away – HRAs Are Still Critical for SNP Success appeared first on Lilac Software.

Star measures for Medicare Advantage (MA) plans get updated every year. The types of changes include major structural changes, changes to the weights of existing measures, new measure specifications, retirement of measures, and introduction of new measures. Lilac’s experts closely monitor all of CMS’ many communication channels to track all confirmed and possible changes.

Our current assessment of upcoming changes is reflected in the table below. We include Star Year (SY) 2026 and Star Year (SY) 2027 for historical and reference purposes. The forward-looking changes reflect the finalization of the 2026 Medicare Advantage Rule in April 2025, the finalization of the 2026 Final Announcement regarding rates and policies in April of 2025, the proposed 2027 Medicare Advantage Rule released in November 2025 (items noted as pending), and the just released 2027 Advance Notice regarding rates and policies in January 2026 (items are noted as possible or non-substantive).

Other Changes Mentioned

Note: Monitoring ECDS conversion. NCQA has a goal of converting all hybrid measures to ECDS by MY 2029 and non-hybrid in MY 2030.

• BCS, COL – DONE
• CBP – MY 2028
• GSD, TRC, COAs  – MY 2029

Changes to All Cause Readmissions, including denied claims inclusion and re-estimation of risk adjustment (2027 Advance Notice — possible in MY 2028 and would require rule-making and updated measure on display).

Changes to Transitions of Care, including ECDS conversion in MY 2028 and Hybrid measure changes for MY 2028, including reducing Patient Engagement and Medication Reconciliation submeasures from 30 days to 14 days (2027 Advance Notice — possible in MY 2028 and would require rule-making and updated measure on display).

Diabetes Care — Blood Sugar Control will convert to ECDS upon successful testing in MY 2029 (2027 Advance Notice — possible in MY 2029 with two-year testing transition).

Additional Universal Foundation measure adoption TBD:

• Adult Immunization at 1x weights (possible SY 2029 or beyond)
• Physical Functioning Activities of Daily Living (possible SY 2029 or beyond)

Polypharmacy: Use of Multiple Central Nervous System Medications in Older Adults (possible – year TBD)

Initiation and Engagement of Substance Use Disorder Treatment (1x) (Not finalized as part of the 2026 MA and Part D rule. Could be proposed again.) 

Initial Opioid Prescribing for Long Duration (1x) (Not finalized as part of the 2026 MA and Part D rule. Could be proposed again.)

Measure specification changes – COA-Functional Status and COA-Medication Review (possible SY 2031 or beyond)

Adjust HEDIS-HOS measures (possible SY 2031 or beyond)

Substantive changes to Plan Makes Timely Decisions about Appeals (Part C) and the Reviewing Appeals Decisions (Part C) (Not finalized as part of the 2026 MA and Part D rule. Could be proposed again. But proposed to sunset both in MA and Part D 2027 rule (pending))

Removal of following beyond what was proposed in the MA and Part D 2027 rule (pending) (possible – year TBD):

• COA measures (3)
• MTM CMR (currently slated to return to Stars in SY 2029)

Remove guardrails for non-CAHPS measures when calculating cut points  (Not finalized as part of the 2026 MA and Part D rule. Could be proposed again.)

Monitoring provision not finalized in 2024 draft rule: Remove “with and without improvement” for 4 and 4.5 Star plans, effectively requiring improvement in calculations for all plans other than 5 Star plans 

Possible use of percentile distribution cutoffs to assign measure Stars vs. clustering (2027 Advance Notice — possible — TBD)

Add Geography toEHO4all  – urban/rural indicator (possible – TBD, but proposed to sunset EHO4all in MA and Part D 2027 rule (pending))

Monitoring others provisions not finalized from draft CY 2026 rule : 

• Clarifying how the EH04all reward factor will be calculated when a contract consolidation applies, when there are data discrepancies, or when data are missing.
• Clarifying how the EH04all reward factor will be calculated when Dual Eligible Special Needs Plan (D-SNPs) offerings migrate from master contracts to free-standing ones.
• Clarifying how the EH04all reward factor will be calculated for Institutional Special Needs Plan (I-SNP)-only contracts.
• Clarifying how the hold harmless provision for highly rated plans is calculated in terms of the addition of EHO4all.
• But, proposed to sunset EHO4all in MA and Part D 2027 rule (pending)

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Lilac’s Stars Management platform helps plans navigate these types of major changes to Stars.  We have the data models and analytics to easily understand the strategic implications of Stars program changes and agentic AI tools to make a plan’s member engagement in support of Stars more efficient and impactful.

 Reach out here to start a conversation with the Lilac team about how we can help your plan.

The post Medicare Advantage (MA) Star Roadmap – Star Year 2026 & Beyond appeared first on Lilac Software.

A Refresher on Proposed Changes

Major measure realignment:

Beginning primarily in Measure Year (MY) 2027/Star Year (SY) 2029, CMS proposes to remove 12 measures (really 14 based on duplication in Parts C and D), largely focused on eliminating operational/administrative measures or those that no longer show variability in quality among plans. CMS also proposes to introduce a new Depression Screening and Follow-Up measure that would begin with MY 2027/SY 2029. This was expected as Universal Foundation measures are rolled out throughout government healthcare programs.

As can be seen below, operational measures were almost one quarter of the overall Star rating. 

EHO4all no more:

The Excellent Health Outcomes for All (EHO4all, the former Health Equity Index (HEI)), will not be implemented for SY 2027 (MY 2025). The Reward Factor would be maintained for consistently high-performing plans. This creates winners and losers. While most plans would see little additional reward under EHO4all initially, many plans have invested heavily in EHO4all in anticipation of the program coming online in SY 2027. And many of these plans do not have a shot at the Reward Factor (you need to consistently score at least in the very high 3s or higher on the overall rating to get it). Those who have consistently received the Reward Factor and do not have a major penetration of health equity populations would benefit from the reversal on EHO4all.

The fallout

All of the changes mean great risk for many plans in terms of Star ratings. 

CMS says this is the estimated impact on Star ratings:

• 62% of contracts will see no impact to Star ratings
• 13% of contracts will see an increase of one-half Star
• 25% of contracts will see a decrease of one-half Star
• One contract would drop by one Star

But what these statistics don’t tell you is that a good proportion of other contracts also see erosion in their Star rating, just not enough to cause a half Star rating reduction. For these other plans, they are then that much further away from increasing their Star rating. Overall, the operational measures were high performing compared with other measure groupings for many plans. More importantly, this helped many plans achieve and maintain higher ratings, especially for 4 Star and above. There was less volatility because of the presence of these admittedly easier-to-hit measures.

Actuarial firms seem to back up that impacts are worse than CMS says. A Milliman white paper shows 30% of contracts could lose half a Star, with a few dropping a full Star. At least 42 contracts may fall below the 4.0 Star level. The number of contracts below 3.5 Stars also increases by 63. And showing the impact on other contracts, the national contract-weighted average for overall Star achievement could decrease by 0.15 Stars.

Wakely just came out with its own analysis that dovetails with the worse impacts found by Milliman. It says the national enrollment-weighted market average for overall Star achievement will drop by 0.25 Stars. This will mean a loss of revenue of 1.4% for MA-Part D (MA-PD) plans and fewer 4 Star plus contracts. The lower Star ratings impact plans of all sizes — top 10, large, mid-size, and small.

The quirky economics of all this is that the reversal of the EHO4all reward and maintaining the Reward Factor means better Star bonuses in the short term for some contracts. But for those not getting a Reward Factor, the economics are bad. And once the measure changes come in, generally speaking things are even worse for most contracts.

Other changes also create some uncertainty

• The return of the Improving HOS measures will be 3x weighted. These are tough cohort measures.
• There are the new COB and POLY-ACH drug safety measures. By the time you see claims for overlapping medications, many are non-compliant for the measure for the year. To succeed, plans will need to adopt a risk-based analysis to stop cohorts of members from violating the overlapping medication policies in each measure.
• The new risk adjustment in the medication adherence measures will benefit some plans but hurt others. Plans need to study the risk adjustment algorithms. Gap closure should continue as is (without adjusting on a member level), but plans do need to understand from month to month how the risk adjustment (RA) process is working globally (this is where the risk adjustment is applied). But studying results at a member level could also be beneficial over time. Remember, these measures are 1x-weighted in SY 2028, but return to 3x-weights in SY 2029.
• With SNP enrollment growing and a push to establish free-standing SNP contracts, the impacts to SNP plans and those with high penetration of dual eligibles and SNP lives are especially important to consider. Studies indicate that highly penetrated SNP and dual plans have overall ratings that are 0.3 lower on average. Outcomes on certain measures can be even worse than that. With operational measures gone, even lower performance for these plans and more volatility is possible.

New Approaches Needed

Given the seismic shift in the Stars program, MA plans do need to think differently about their approach.

• Contract-level impact assessment: Conduct an assessment of contract-specific impacts for your contract(s). Are you one of the plans that loses a half Star on your contract(s)? Does the impact reduce your potential to increase your Star rating over time even if you do not drop a half rating?
• Strategic planning rigor: Planning becomes more of a necessity than before. Ongoing strategic planning during the measure year is key. 
• Sustained quality investment: MA plans will need to invest more and consistently in quality improvement budgets. Investments in improvement by measure and holistically at enterprise level capabilities are key. 
• Cut-point proximity analysis: Plot your strategy by looking at how close you are in a given year and across years to certain higher cut points. Mine the data to see what investments make sense in the current year and into the next.
• CAHPS and HOS prioritization: CAHPS and HOS have been trouble spots for many, but now become a key focus. Almost 40% of overall ratings are rooted in these measures as of SY 2029 and substantial investment is needed. These measures must be worked over a series of years. Understanding your members and then remediating issues are both required. Particular attention should be focused on the 3x weighted Improving HOS measures. These will be the Achilles’ Heel for many.
• HEDIS and medication adherence execution: That said, HEDIS clinical and drug measures now will be close to one half of overall ratings. Highly weighted medication adherence measures require daily attention and the freshest of data. Clinical measures require fresh data and concerted efforts each week and analysis each month to drive changes. The event-based HEDIS measures – PCR, TRC, and FMC – all tend to be poorer performing and require substantial investment in several areas. On a retrospective basis, review provider group performance for outliers and success stories. On a proactive basis, train on interoperability and documentation in the medical record of admission and discharge notification. Stress the need for patient engagement within 30 days for inpatient admissions and 7 days for emergency room visits.
• ECDS readiness strategy: You must have an electronic measure ECDS strategy. NCQA has a goal of converting all hybrid measures to ECDS by MY 2029 and non-hybrid by MY 2030. Many plans struggled with COL conversion in SY 2026 and there will be more of this to come without a coherent strategy and investment. In terms of hybrid measures, CBP could hit in MY 2028 as well as GSD, TRC, and the COAs in MY 2029.
• Universal Foundation preparedness: Plan now for the further phase-in of Universal Foundation measures. Depression Screening and Follow-up will hit in SY 2029 but more are sure to come. CMS has telegraphed this. Watch, too, for the following, which were once proposed for Star inclusion but not finalized: Initiation and Engagement of Substance Use Disorder Treatment, Initial Opioid Prescribing for Long Duration, and Polypharmacy: Use of Multiple Central Nervous System Medications in Older Adults.
• Monitor other proposed changes: Some plans will also monitor the following changes that could be made that were proposed in the past but not finalized.
  • Removing guardrails for non-CAHPS measures when calculating cut points. This was not finalized as part of the 2026 MA and Part D rule. 
  • Removing “with and without improvement” for 4- and 4.5-Star plans, effectively requiring improvement in calculations for all plans other than 5 Star plans. This was not finalized as part of the 2025 MA and Part D rule.

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Lilac’s Stars Management platform helps plans navigate these types of major changes to Stars.  We have the data models and analytics to easily understand the strategic implications of Stars program changes and agentic AI tools to make a plan’s member engagement in support of Stars more efficient and impactful.

 Reach out here to start a conversation with the Lilac team about how we can help your plan.

The post The Upcoming MA Stars Overhaul – Implications and How Plans Can Prepare appeared first on Lilac Software.

Across Medicare Advantage, Medicaid, and commercial plans, several themes are emerging about where AI is delivering meaningful results today and where its biggest potential lies over the next 3–5 years.

1. AI Works Best When It Improves Efficiency at Scale

Whether in care management, prior authorization, quality reporting, or provider documentation, AI’s most successful early wins come from eliminating tedious, repetitive tasks and accelerating processes that already have clear rules.

Examples of high-impact efficiency gains

• Automated summarization & dictation: Clinicians and case managers gain back hours per week through AI-powered chart summaries, dictation tools, and pre-visit prep. 
• Faster prior authorization reviews: AI can rapidly map requests against state and federal regulations, speeding up approvals (especially important for Medicaid plans). 
• Structured data extraction: Plans use AI to pull relevant clinical information from unstructured notes for HEDIS, Stars, and risk adjustment. 

These improvements don’t replace the clinician or care manager. They make their work more effective and reduce the administrative load that drives burnout.

2. Quality, Stars, and HEDIS Are Becoming Prime Targets for AI Innovation

Quality teams are among the most overextended groups in any health plan. AI offers a direct way to remove friction in closing gaps, forecasting performance, and driving member interventions.

Where AI is gaining momentum in quality

• Near-real-time gap identification across all members and measures 
• Reducing unnecessary outreach by predicting which members are unlikely to close gaps without help 
• Aggregating clinical data automatically from disparate providers 
• Improving member experience which is especially critical as CAHPS weighting increases 

Plans are especially focused on AI that can translate fractured, unstructured data into actionable insights, allowing them to deploy resources more strategically.

3. Fraud, Waste, and Abuse (FWA) Is Becoming an AI Priority Area

FWA is an area where AI can outperform humans by identifying patterns that aren’t obvious through manual review.

Emerging AI use cases in FWA include:

• Detecting abnormal billing patterns 
• Identifying outlier providers or services 
• Learning from historical fraud cases to catch new ones faster 

As Medicaid and Medicare oversight intensifies, plans are increasingly prioritizing this capability.

4. Provider Organizations Benefit from Predictive and Proactive Engagement

On the provider side, AI is showing strong results in:

• Predicting deterioration in patients with CHF, COPD, diabetes, and other chronic conditions 
• Remote monitoring triage to determine which patients need immediate outreach 
• Post-discharge follow-up, where AI-driven calling agents or workflows dramatically improve 3-day follow-up rates 
• Documentation accuracy and pre-visit planning 

For clinicians, the value is simple: less time searching for information, more time caring for patients.

5. Successful AI Adoption Requires Clear Governance and a Problem-First Mindset

Organizations that succeed with AI share a few traits:

Core components of strong AI governance

• A cross-functional governance council (IT, data, clinical, quality, compliance) 
• Clear policies for data security, regulatory monitoring, and model validation 
• A framework for evaluating internal build vs. vendor partnerships 
• Continuous QA testing to ensure accuracy before scaling 

Common adoption pitfalls

Plans that take a thoughtful, governed approach avoid wasted spend and build confidence internally.

6. The Next 3–5 Years: What Will Become Standard for Health Plans

Both clinical and operational leaders anticipate a major shift in foundational AI capabilities. The following will likely become standard:

Predicted baseline capabilities by 2028

This evolution will redefine payer operations—making AI as essential as claims processing systems are today.

7. Where Plans Should Invest Now

To stay competitive, health plans should prioritize investment in:

High-ROI starting points

• Member services AI (proven to outperform human CSAT in several plans) 
• Quality and Stars automation 
• FWA analytics 
• Predictive models for care management 
• AI governance infrastructure 

Foundational data capabilities

Plans still struggling with ADT feeds, HIE integration, or fragmented EMRs should address these gaps early—AI is only as powerful as the data feeding it.

Final Takeaway

AI is not a future concept—it is already transforming core health plan operations. But the biggest breakthroughs come when AI is paired with strong governance, thoughtful prioritization, and a commitment to enhancing (not replacing) the human side of healthcare.

Health plans that build these capabilities now will be the ones that deliver better quality scores, lower administrative burden, more personalized member experiences, and ultimately, stronger financial performance—well ahead of those who wait.

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Lilac Software is building agentic AI capabilities into our platform to help health plans automate complex operational workflows. 

If you’re interested in learning how these systems can transform your plan’s operational efficiency, reach out here to start a conversation with the Lilac team.

The post AI in Action: What’s Really Working for Health Plans Today and What Comes Next appeared first on Lilac Software.

CMS’ Overhaul: Operational Measures Out, Clinical Intensity In

CMS’ draft MA & Part D rule (published Nov 25) proposes removing 12–14 operational/administrative measures beginning Measure Year 2027 / Star Year 2029 (with a few measures removed earlier). The removals shift Star “power” toward drug, HOS, and quality improvement measures by SY 2029 as well clinical measures after that.

Measures CMS Proposes to Eliminate

Key takeaway: CMS is stripping out nearly all operational measures, forcing plans into a more clinical-outcome-driven Stars landscape.

Shift in Star Weighting: Operational Drops to Zero

The changes above have the effect of transferring so-called Star power to drug, HOS survey, HEDIS clinical, and quality improvement measures. Below is the impact on relative weighting of measure groups toward the overall rating from Star Year 2026 (the just released Star year) vs. Star Year 2029 (the year all proposed changes will be in effect). Note that SNP-only plans have slightly different percentages but they are very close to these numbers.

Let’s look at this another way. The impact of CAHPS and HOS survey measures increases dramatically. These are not easily trackable as say HEDIS and drug measures are. You need to ensure the entire population is happy with their healthcare and outcomes in order to ensure excellent performance on these annual sample measures. This complicates consistent achievement as well as rating predictions for all plans. And moving these types of measures are muli-year.

The Surprise Reversal: EHO4all Paused, Reward Factor Returns

Key takeaway: Plans that invested in EHO4all may get zero benefit, while historically strong plans gain an advantage.

If the new rule is implemented as is, CMS will not implement EHO4all in SY 2027; instead, the Reward Factor will stay. If you look at how national, regional and smaller plans might or might not benefit from the change, we find:

• The larger regional plans benefit the most from restoring the Reward Factor as they tended to be the most consistent high performers.
• Most of the big national players have had some benefit from the Reward Factor in the past but not as much as the larger regional players. At the same, they are making heavy investments in Special Needs Plan (SNPs) and attracting dual eligibles. Meaning, they could perhaps go either way on this. But given their woes, they are likely satisfied with no more upheaval in Stars right now if the Reward Factor stays.
• Certain poorer performing national plans likely would have done better under the EHO4all, but that assumes they can serve dual eligibles better than they do today.
• The losers may be some of the smaller plans with high concentrations of dual eligibles and SNPs who have not traditionally scored well but counted on the EHO4all to move them up the Star scale.

• Winners: Plans already scoring high overall (consistent 4+ Star performers).
• Losers: Plans that heavily invested in EHO4all preparation for SY 2027.
• Risk: Timing of the reversal—one month before MY 2025 ends—may raise due-process challenges.

The real question about this change is whether plans are getting due process. There is a legitimate issue for plans to raise when the government proposes to zero out the EHO4all in a draft rule with just one month remaining in Measure Year 2025 and when the final rule will not be adopted until well after the measure year has concluded. Some plans would have a strong case in challenging the provision. After all, the original HEI proposal (the precursor to EHO4all) went through full rulemaking back in 2023. Plans had sufficient notice to prepare for the major change. They will not now.

New Measure Coming: Depression Screening & Follow-Up

Key takeaway: Universal Foundation measures continue to enter MA Stars, bringing more complex clinical requirements.
A new Depression Screening and Follow-Up measure will join the program in MY 2027/SY 2029.

CMS’ Estimated Impact on Star Ratings

Key takeaway: A quarter of plans drop; one in eight rise; most stay flat.

What’s Changing and When

The following synthesizes confirmed, proposed, and potential changes. Proposed items from the 2027 rule are bolded.

Measure Year 2025  (Star Year 2027)

Key takeaway: Major drug-safety measures arrive, HOS gets heavier, and COA measures reshuffle.

• Reward Factor retained; EHO4all not implemented (proposed).
• HOS Physical & Mental Health measures increase from 1× → 3× weights.
• COA Pain Assessment removed; COA Functional Status Assessment returns.
• Two difficult polypharmacy/drug safety measures begin:
  • COB (Concurrent Use of Opioids & Benzodiazepines)
  • Poly-ACH (Polypharmacy Anticholinergic)
• Diabetes Eye Exam loses chart review option (≈2-point performance hit).
• Statin Use in Diabetes gets new tolerance exclusion.
• Removal of MRP and MTM-CMR.

Measure Year 2026 (Star Year 2028)

Key takeaway: Adherence measures drop in weight and get risk adjustment—fundamentally changing performance dynamics.

• All three adherence measures drop 3× → 1× weight.
  • New risk adjustment based on age, sex, LIS/dual, disability.
  • Removal of inpatient/SNF adjustments.
• Statin Therapy (SPC) moved to Display due to specification changes; proposed elimination in MY 2026/SY 2028.
• Call Center measures proposed for removal in MY 2026/SY 2028.

Measure Year 2027  (Star Year 2029)

Key takeaway: Large measure removals and expansions further increase clinical difficulty.

• Breast Cancer Screening age drops to 40.
• CMS proposes eliminating: Appeals, SNP Care Mgmt, Complaints, Disenrollment, Price Accuracy, Eye Exam, CAHPS Service, CAHPS Quality.
• Depression Screening & Follow-Up added to Star (Display requirements will have been met).

Later Years

Key takeaway: Widespread ECDS conversions and more complex measures are coming.

• NCQA aims to convert all hybrid measures to ECDS by MY 2029 and non-hybrid by 2030.
• Several challenging measures (e.g., Blood Pressure, A1c, TOC, COA suite) slated for ECDS conversion.
• Substance use disorder measures likely to reappear in future proposals.
• Additional Universal Foundation measures possible (e.g., Immunizations, ADLs).
• Possible elimination of guardrails for cut points as well as possible elimination of improvement vs. no-improvement” scoring calculation for 4 and 4.5 Star plans.

The SNP Effect: Growing Enrollment, Lower Performance

Key takeaway: SNP growth and D-SNP carve-outs will structurally depress Star ratings for many contracts.

• SNPs now represent one-third of MA plans and 22% of all MA enrollment.
• D-SNP performance averages ≈0.3 points lower, with adherence measures more than double that impact.
• CAI helps but does not fully compensate for the performance gap.
• More plans shifting into D-SNP-heavy contracts may see declining Stars despite strong operations.

Bottom Line

If CMS finalizes its proposed framework, the Stars program becomes far more clinically demanding and far more difficult for plans with vulnerable populations.

• Billions in bonus payments are at risk.
• Plans must invest in faster data, better forecasting, and more scalable interventions.
• Success will hinge on the ability to identify gaps earlier and activate interventions at scale—especially for drug safety, adherence, and HOS.

If you want deeper commentary on all the changes and analysis about the implications, check out an accompanying article on The Healthcare Labyrinth. 

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Lilac’s Stars Management platform helps plans navigate these types of major changes to Stars.  We have the data models and analytics to easily understand the strategic implications of Stars program changes and agentic AI tools to make a plan’s member engagement in support of Stars more efficient and impactful. Reach out here to start a conversation with the Lilac team about how we can help your plan.

The post A New, Tougher Stars Era is Coming. Are MA Plans Ready? appeared first on Lilac Software.

In a recent edition of The Healthcare Labyrinth Podcast, Lilac’s Marc Ryan unpacked the most recent Star rating data to tease out key insights. The podcast is embedded above and below is a summary. You can subscribe to The Healthcare Labyrinth Podcast on your favorite podcasting app.

The 2026 Star Ratings results reveal a Medicare Advantage (MA) landscape at a turning point. After years of declining performance following the COVID flexibility era, Star ratings have finally stopped their slide. But stabilization should not be mistaken for recovery. The industry remains well below historical norms, measure volatility persists, and new regulatory requirements will make 2027 even more challenging.

For health plans, this moment represents both a warning and an opportunity: a reminder that Stars success now hinges on real-time analytics, operational precision, and scalable member engagement approaches.

1. The Industry Picture: A Pause, Not a Rebound

Across the 481 contracts rated in both SY25 and SY26:

• 29% dropped by ≥0.5 stars
• 26% improved by ≥0.5 stars
• 45% showed no change
• Average contract score increased slightly (3.63 → 3.65)
• Enrollment-weighted average rose from 3.92 → 3.98
• 40% of contracts achieved 4★+ (flat vs SY25)
• 64% of MA enrollment is in 4★+ plans

Takeaway:
The industry has stabilized, but at a low plateau. Many plans remain stuck in the 3–4 star range, and the proportion of high performers continues to shrink.

2. How the Major Plans Performed

Performance among the largest MA organizations shows a wide split:

Interpretation:
Big-plan inconsistency continues to pull down the national average. Kaiser remains a standout, while others either plateau or decline.

3. The New Normal: More Plans Clustering in the Middle

The distribution of contract ratings has shifted meaningfully since 2022:

This illustrates a long-term structural shift:

• Far fewer contracts sit at the top.
• The “middle tower” continues to grow.
• Lower-performing contracts have multiplied dramatically.

4. Measure-Level Insights: Where Plans Improved, and Where They Struggled

Improving Measures

• Controlling high blood pressure
• Statin therapy for cardiovascular disease
• Medication reconciliation post-discharge
• Colorectal cancer screening (helped by guardrails and ECDS shifts)
• Call center performance (Part C & D)

Declining Measures

• Breast cancer screening
• Care for older adults – pain assessment
• Bladder control
• Plan all-cause readmissions
• Follow-up after ED visits

Medication Adherence Remains a Pain Point

All three adherence measures remain flat or slightly down (scores 3.1–3.3), and all are triple-weighted in SY27, making them outsized drivers of upcoming financial outcomes.

5. What’s Coming in Star Year 2027

Plans should prepare for a significantly harder measurement year:

New High-Risk Medication Measures

• Concurrent opioid + benzodiazepine use
• Anticholinergic polypharmacy in older adults

These require earlier detection and faster, targeted outreach. This needs to be done before most data systems typically surface overlap issues for optimal results.

Methodology Shifts

• EHO4All replaces the Reward Factor (likely reducing score contribution for many plans)
• Expanded use of ECDS measures
• Broader age band for colorectal cancer screening (45–75)
• Return of functional status assessment
• Removal of chart review for the diabetes eye exam

Implication:
Operational agility will become even more important as CMS rules diversify and intensify.

6. The Strategic Imperative: Better Data, Faster Execution

Star Ratings performance is no longer just a function of clinical quality. It is a function of data clarity, intervention speed, and scalable execution.

This requires:

1. Unified and Timely Data Infrastructure

Plans must be able to see measure risk in real time, not months late due to fragmented claims, pharmacy, and ECDS flows.

2. Predictive Identification of At-Risk Members

Early detection of emerging medication issues or declining adherence is critical, particularly for overlapping-medication measures where compliance can be lost early in the year.

3. Scalable Outreach and Follow-Through

As measures grow in complexity, traditional call-center-only approaches cannot keep up.
Agentic AI-driven workflows — blending automated voice, scripting, digital messages, and staff routing — can help close gaps efficiently at scale.

4. Continuous Scenario Modeling

With multi-year lags and yearly methodology changes, plans increasingly need to model:

• Measure trajectories
• Member-level risk
• Financial impact under multiple scenarios

7. A More Sustainable Path Forward

The stabilization in SY26 shows that industry performance is not in free-fall. However, the underlying challenges have not gone away. In many respects, the tough environment is a sign that the program is working as intended: constantly raising expectations for quality and member experience.

A few well-placed capabilities will differentiate the plans that rise:

• Strong analytics to interpret measure movement
• Integrated data systems that minimize lags
• Workflows that connect insight → action → outcome
• Smart automation and agentic AI to expand operational reach
• Leadership alignment around continuous-year Stars management

These elements give plans not only the ability to respond, but to get ahead.

Lilac Software works with plans to support these capabilities — particularly in data readiness, measure analytics, and agentic-AI-powered engagement — but the message is broader than any one solution: Stars success now depends on building a system that can think, adapt, and act continuously.

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Lilac has deep expertise in helping MA plans reach 4+ Star performance through AI powered technology.  Reach out here to start a conversation with the Lilac team about how we can help your plan.

The post (Podcast) MA Star Year 2026 Data Deep Dive: Stability Arrives, but Challenges Intensify appeared first on Lilac Software.

A great deal of focus on the Medicare Advantage (MA) Stars front has been on the plight of the largest plans when it comes to quality achievement. Star ratings collectively peaked in 2022 as COVID flexibilities were in place in terms of measure and rating calculations. In the three Star years following, collective Star ratings plummeted. In Star Year 2026, we see stability but not really recovery. So, slightly positive news, but not really good news. 

But what does the data tell us about the other 25% of enrollment in regional and smaller plans? 

Lilac looked at Star Year 2026 results from two perspectives – tenure of contracts (not organizations per se) and size of contract membership. It tells an interesting story – that regional plans have higher ratings than the largest ones and that as plans age in the MA program and grow, Stars achievement increases.

 Let’s look first at tenure. It stands to reason that newer plans know less about Stars when they start and gain knowledge of best practices over time. Thus, plans under five years tend to have fewer high performing plans – just 18.2% in SY 2026 had ratings of 4 Star and greater. (Admittedly, the 3.5 Star default rating in the first few years impacts the calculation a bit). But the data show that as plans enter the 5-to-10-year tenure category, the Star rating increases dramatically – 48.6% of contracts had ratings of 4 Star or greater. This compares to 40.1% of all contracts. 

There is even reason to believe that tenure above 10 years might breed a bit of complacency as just 39.9% of contracts hit 4 Star and greater. Some of this could be influenced by poor large player performance right now but the statistics over time seem to bear out this tenure-complacency factor. 

So, let’s turn to contract size. We see a similar pattern emerge – medium-sized MA contracts tend to perform best. Contracts between 50K and 100K have a 4 Star or greater rating percentage of 65.1%, with contracts between 25K and 50K enrollment at 48.6% and plans between 100K and 500K enrollment at 48.8%. The average overall ratings for these groupings also are among the highest with a few exceptions at the bottom and top. 

Now, when the largest players perform well, they tend to have 4 Star and greater contract enrollment percentages that rival the mid-size plans. But that there is inconsistency for the biggest contracts points to another factor beyond tenure complacency that may influence achievement. As the organization gets bigger and bigger, additional complications of ensuring the highest performance emerge. Challenges with disparate data, a lack of agility to respond to clinical changes, and a lack of connectivity with members and providers seem to emerge. An argument could be made that decentralizing Stars administration could offset these barriers in big organizations, but that in and of itself breaks critical coordination and standardization needed to ensure consistent performance.

What does all this tell us?

First, the sweet spot for size may be in the middle and bigger is not always better. Medium-sized plans appear to have the sophistication to succeed and the important connectivity to members and providers needed to monitor and drive results. 

Second, while newer plans and smaller plans initially struggle, they do learn and adapt over time. Most of them graduate and become the sophisticated medium-sized plans in the middle in terms of tenure and size. 

So, the future may very well lie in the middle. While big plans dominate enrollment right now, their penetration has dropped every so slightly of late, signaling a potential shift in the MA market. All plans need to improve quality achievement, but the data show a compelling business proposition for MA generally for new entrants and regional players. At the same time, the growing complexity of Star is not for the faint of heart. Sophistication, agility, and resiliency will always be key to consistently high Star performance.

Lilac Software can help you build that sophistication, agility, and resiliency. Learn more about our best-practice approach to Stars data, forecasting and improvement – backed by the power of agentic AI here. 

Or reach out here to start a conversation to discuss how we can your plan.

The post What the Data Say: Why Smaller and Newer MA Plans Are Climbing the Stars Ladder appeared first on Lilac Software.

This article distills actionable lessons from Lilac’s recent webinar covering how smaller and newer MA plans can punch above their weight class and outperform in Stars. Our learnings come from years of hands-on experience in Stars operations, compliance, and technology innovation. The webinar (recording above) and this article are designed to help Stars leaders at smaller and newer plans not only compete but win in an increasingly challenging Stars environment.

Understanding the Performance Curve

Data across the MA landscape shows clear performance patterns by both plan size and plan age.

Key Findings Based on Plan Size

• Small plans (under 25k members) tend to be the lowest performers on average.
• Mid-sized plans (25k–500k members) is the highest performing segment, with enough resources to invest in organizational and technology infrastructure and the agility to move fast.
• Large plans (500k+ members) are middle performers on average with a few national plans seeing regression in a significant portion of contracts.

Key Findings Based on Plan Age

• Young plans (under 5 years) struggle the most with an average Star rating of 3.45, which is largely a product of resources and program maturity.
• Middle aged plans (5-10 years) by far perform the best as they tend to have the best balance of maturity and innovation.
• Older plans (over 10 years) have scores above the younger plans but below the middle-aged plans, which might indicate challenges associated with organizational ossification.

Lesson 1: Strengthen Your HEDIS Vendor Partnership

Your HEDIS vendor relationship can be a big needle mover in your plan’s Star performance. For smaller plans, the right data cadence and transparency are what you need to establish quickly.

What to Expect from Your Vendor

• Frequent data runs: Demand monthly or quarterly runs and not just annual snapshots.
• Minimal data lag: Faster cycles enable real-time interventions.
• Granular reporting: Ensure access to subpopulation and equity-level breakdowns to support EHO4All calculations.

Plans relying solely on year-end reports are too late to act. The best-performing smaller plans treat their HEDIS vendor as a strategic partner to engage continuously, not a compliance function to engage transactionally.

Lesson 2: Use Agentic AI to Expand Member Engagement Capacity

Smaller teams are closer to members but still face challenges engaging every member for every care gap, medication need and staying in tune with satisfaction levels. The challenges lie in orchestration and thoughtfully orchestrating all types of outreach for maximal impact without risking abrasion. This is where agentic AI can be a difference maker.

AI powered systems now allow plans to:

• Reliably merge data from scattered spreadsheets into one unified member profile.
• Generate personalized outreach recommendations based on member history and overlapping measures.
• Automate voice, SMS, or email outreach across all parts of the risk spectrum, which frees up human staff for higher-touch engagement.

In short: Agentic AI isn’t a replacement. It’s a multiplier!

Lesson 3: Make CAHPS and HOS a Central Pillar

Member experience measures are no longer “soft” metrics. They now carry significant weight – up to 25% of overall Stars scores when combined.

Where to Focus

• Ownership: Assign clear responsibility for CAHPS and HOS performance.
• Continuous feedback: Use pulse surveys and micro-feedback loops to detect member sentiment early.
• Engage the “neutral middle”: Identify and follow up with members who rate you 6s and 7s, not just the extremes.
• Track wellbeing trends: Use claims, case management, and social data to identify members with declining health or mobility before survey season.

Small plans have the proximity and personal relationships to outperform on these measures. They just need systematic tracking and tools for continuous engagement.

Lesson 4: Manage PBMs Like a Strategic Extension of Your Team

PBMs vary dramatically in how much Stars support they provide. Smaller plans often get less attention. Proactivity (and pushiness) matters.

The Best PBMs Offer

• Near real-time adherence tracking (daily or weekly).
• Predictive risk scoring to identify members likely to become noncompliant.
• Root-cause analysis for why gaps occur and how to close them.
• PDE reconciliation to catch CMS errors that can cost you points.

If your PBM can’t deliver this level of support, supplement with analytics tools that do. Lilac has built out a full suite of medication adherence and drug measure modules to help in this mission critical area.

Lesson 5: Track Operational Measures Daily

Operational metrics like appeals, call center response, and CTMs are highly sensitive for small plans. Just a few errors can cost a star.

Best Practices

• Daily monitoring: Treat every case as critical.
• Early auditing: Fix pharmacy and PDE data before CMS deadlines.
• Plan preview review: Recheck for misclassified calls, appeals, and CTMs.
• Scenario modeling: Stay ahead of potential CMS measure changes and their impact on total Stars scoring.

Operational precision is one of the few areas where small plans can outperform much larger peers through vigilance and speed.

Lesson 6: Stay Ahead of CMS and Market Changes

Stars is evolving faster than ever—with new measures, weighting shifts, and equity adjustments. Successful smaller plans are those that plan forward, not react backward.

• Model Stars scenarios annually to understand how new measures or weighting will impact your contract.
• Pilot future measures early, especially HEDIS updates and polypharmacy metrics.
• Integrate real-time forecasting tools to identify where to invest resources before cut points are finalized.

Agility isn’t just an advantage. It’s your moat.

Lesson 7: The Bottom Line: Small, Smart, and Strategic Wins

Stars excellence for smaller and newer MA plans isn’t about scale. It’s about precision, speed, and member focus.

Winning plans:

• Start Stars management from day one.
• Build real-time visibility into every measure.
• Use Agentic AI to extend limited staff capacity.
• Treat satisfaction and engagement as core operational priorities.
• Audit relentlessly and fix errors early.
• Adapt faster than the competition.

With the right data foundation and modern automation, small plans can outperform at any scale. Smaller and newer plans have a distinct opportunity to transform agility into their most powerful competitive advantage.

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Lilac has deep expertise in helping smaller and newer plans leapfrog the maturity curve through AI powered technology.  Reach out here to start a conversation with the Lilac team about how we can help your plan.

The post (Webinar) Outperforming at Any Scale: Achieving Stars Success at Small, Mid-Sized and Newer MA Plans appeared first on Lilac Software.