Every fall, quality teams shift into overdrive. Phone banks spin up. Outreach campaigns launch. Care coordinators work extended hours to reach members who haven't completed screenings or filled prescriptions. It's exhausting, expensive, and—for many plans—not nearly as effective as they need it to be.
It’s a timing problem more than anything. By the time most plans enter crunch mode, the window to meaningfully move most clinical measures has already closed.
Take blood pressure control, one of the most heavily weighted clinical measures. According to research in the American Journal of Managed Care, plans achieving 5 stars on medication adherence measures were 4.6 times more likely to achieve 5 stars on controlling blood pressure.
This is no coincidence: blood pressure control requires months of consistent medication adherence and regular monitoring. A phone call in October can still help—identifying a missed refill or correcting how a member takes their medication—but it's unlikely to be enough on its own to achieve sustained control if adherence gaps have been accumulating since January.
The BP measure captures the last reading of the year—so a late intervention can technically move the needle if it results in a controlled reading. But relying on Q4 outreach to surface and resolve these gaps is a high-risk strategy. Members identified earlier have more time for medication adjustments, follow-up visits, and the kind of sustained engagement that produces reliable results.
The same pattern holds across most clinical measures. Breast cancer screening requires not just scheduling an appointment but ensuring the member actually completes it. The scheduling backlog at most imaging centers means October outreach often isn’t enough to secure appointments before year-end.
Similarly, bladder control discussions can technically happen at any visit—including December—as long as the provider asks the right questions and documents the conversation. But identifying members with potential needs earlier in the year creates more time to address those needs meaningfully, rather than racing to check a box before the measurement period closes.
The 2026 Star Ratings data tells a clear story about which plans are succeeding. According to Becker's Payer Issues, The average MA-PD rating dropped from 4.14 in 2023 to 3.98 in 2026. Advisory Board reports that only about 40% of contracts earned 4+ stars, with just 3.5% achieving 5-star ratings.
But here's a telling detail: according to the CMS 2025 Star Ratings Fact Sheet, MA-PDs with 10+ years in the program are significantly more likely to achieve 4+ stars compared to contracts with fewer than five years of experience. Simply put, veteran plans have had time to build the year-round quality infrastructure that newer plans are still scrambling to develop.
Mature plans have learned—often through painful trial and error—that reactive quality management doesn't scale. The plans consistently hitting 4+ stars aren't working harder in Q4; they're working smarter all year.
Year-round quality infrastructure doesn't eliminate the Q4 push—it changes what that push looks like. When assessment and outreach happen throughout the year, the gaps that remain in October are more manageable: members already identified, appointments already scheduled, conversations already started. The alternative is trying to surface, prioritize, and resolve everything in the final quarter—a volume problem that no amount of effort can fully solve.
The plans that consistently outperform share several characteristics:
They know where they stand on key measures monthly—not quarterly—and can identify emerging problems before they become crises. A member who misses their second blood pressure medication refill in March gets intervention in April, not October.
They use data to identify members most likely to fall out of adherence or miss screenings before it happens—not after the measurement period has already captured the gap. Early identification creates time for relationship-based interventions that actually work.
Quality isn't siloed in a single department. Clinical operations, pharmacy, member services, and finance all have visibility into quality performance and accountability for contributing to it. When everyone owns quality, problems get addressed faster.
High-performing plans have established relationships with provider networks that include shared quality data, aligned incentives, and collaborative workflows for gap closure. These relationships take years to build—and they can pay dividends that Q4 outreach campaigns can't match.
The financial stakes make this more than an operational preference. According to KFF analysis, federal spending on Medicare Advantage quality bonus payments has more than quadrupled since 2015, reaching at least $12.7 billion in 2025. Plans that achieve 4+ stars receive approximately a 5% boost to their benchmarks.
The pressure is increasing. The CMS 2026 Star Ratings Fact Sheet indicates that Physical and Mental Health measures will triple in weight from 1 to 3 in 2027. Plans that are underperforming on these measures today have 12 months to build the infrastructure required to move them. That infrastructure can't be deployed effectively in a Q4 sprint.
For plans still operating in reactive mode, the transition to year-round quality management requires honest assessment of current capabilities and strategic investment in infrastructure that takes time to build.
The good news: you don't have to replicate a decade of infrastructure development overnight. Technology solutions—particularly remote patient monitoring and data analytics platforms—can compress the timeline significantly. The key is starting now, when there's still runway to build capabilities before they're needed for 2027 performance.
For the full breakdown of 2026 methodology changes and what they mean for 2027 revenue, download our comprehensive analysis: 2026 Star Ratings: Key Findings and Recommendations