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CMS will stop scoring complaints, disenrollment and customer service. The behavior behind those measures will keep deciding retention, CAHPS and revenue.
This month every Medicare Advantage plan is reading its 2027 Star Ratings. About half of the cut points got harder this year, and most of the increases sit in clinical measures. In the same year, CMS finalized a rule that removes a group of measures our industry has managed closely for years. Complaints about the plan, members choosing to leave, and the CAHPS customer service measure all come out of the 2029 Star Ratings. The call center interpreter and TTY measure goes a year earlier.
I understand the conclusion some budget conversations will reach. Clinical thresholds are rising, benefits are leaner, and here is a set of member service measures that will soon stop earning a star. It seems reasonable to ask why they should be funded at the same level.
CMS has changed what it scores. It has not changed what members do.
What stops being scored still happens
A frustrated member will still call Medicare to complain. A new member who feels let down in January can still switch plans until March 31. A member who was transferred three times will still remember it when a CAHPS survey arrives. Each measure was only ever a count of moments like these. When the count goes away, the moment stays, and its cost lands on a different scorecard.
Four measures are leaving. Follow one to see where it goes.
Complaints about the plan
- Stops counting in: 2029 Star Ratings
- The member still Calls 1-800-MEDICARE when the plan has not solved the problem.
- Where it lands now The overall rating of the plan on CAHPS, CMS compliance oversight, and the decision to stay or go.
- What we have seen 54% fewer member escalations, and 34% fewer offline escalations, after persona-based training for a managed Medicare plan. Read the case study
Members choosing to leave
- Stops counting in: 2029 Star Ratings
- The member still Can move to another plan until March 31 if the first weeks disappoint.
- Where it lands now Enrollment revenue, acquisition cost that never pays back, and the benefits you can afford next year.
- What we have seen 50% of the members we assisted with a lapsed premium brought it current and kept their Medicare drug coverage. Read the case study
Customer service (CAHPS)
- Stops counting in: 2029 Star Ratings
- The member still Remembers the transfers, the hold time and the answer that turned out to be wrong.
- Where it lands now Rating of health plan, getting needed care and care coordination, which are all still surveyed.
- What we have seen NPS rose from 25 to 37 after analytics traced callbacks to their cause and scripting was pared back. Read the case study
Interpreter and TTY availability
- Stops counting in: 2028 Star Ratings
- The member still Needs to be understood in their own language on the first call.
- Where it lands now Repeat calls, handle time and satisfaction among the members who are hardest to reach.
- What we have seen CSAT up 35% and handle time down 10% with bilingual pods and real-time translation for a Medicare and Medicaid plan.. Read the case study
The measures that remain depend on the same conversations
Look at what is left. Getting needed care, getting appointments and care quickly, care coordination and the overall rating of the plan are all still surveyed. By one industry estimate, CAHPS and the Health Outcomes Survey together will carry close to 40% of the total Star weight by 2029. Gap closure and medication adherence still need a member to answer, trust the person on the line, and act. A new depression screening and follow-up measure arrives in 2029, and that asks for a more careful conversation than most outreach scripts allow.
These measures are not won in the quality department alone. They are won in the contacts a member has with the plan. For one Fortune 50 Medicare Advantage plan, our teams reached members by phone, text, email and IVR to help them book preventive screenings. Over two years, scheduled appointments rose 2.8 times while the cost of the program fell 70%.
Small gaps create large consequences
Experience, Stars, retention, clinical outcomes and cost are usually managed as five subjects with five owners. In my work with health plans I see them as one problem viewed from five scorecards. A member who cannot find urgent care goes to the emergency room. A member who cannot get an answer calls back, then complains, then leaves.
The encouraging part is how often the fix is to remove something. For a large managed Medicare plan, we rebuilt training around member personas and the top reasons people call. Escalations fell 54% and calls were 12% shorter. For another Medicare Advantage plan, analytics showed that rigid scripting, dead air and internal transfers were driving callbacks. Once the scripting was pared back, NPS rose from 25 to 37.
Three questions for your 2027 plan
- Which departing measures did we manage as a number, and what member behavior sat behind each one?
- Who owns that behavior once nobody reports on it?
- What will our January members meet in their first 60 days, and who will reach them before they have to call us?
Measurement year 2027 begins on January 1. That is the day these measures stop counting toward a star. It is also the day your new members arrive.
Fix the moment, not the volume.
See how ResultsCX helps Medicare Advantage plans find member friction early and remove it.