Unlocking Value in CMS Stars: Insights and Strategies for 2026

Where Should Scarce Resources Go for the Biggest Impact?

Healthcare organizations face a persistent challenge: how to allocate limited resources for the greatest return, especially when striving to improve CMS Stars scores. With the release of the 2026 CMS Stars data, several intriguing opportunities have emerged. As we dive into the data, it's important to remember that these observations reflect correlations, not necessarily direct causation, much like the relationships seen in medical research. Still, understanding these connections can help us propose effective strategies for improvement.

Key Correlations in the 2026 CMS Stars Data

• Colorectal and Breast Cancer Screenings: Across 769 contracts reporting ratings data, there's a strong correlation (0.78) between colorectal cancer screening and breast cancer screening. Both require patients to visit a primary care provider (PCP), obtain a referral, and see a specialist, making them two-step processes. The shift to electronic clinical data systems (ECDS) may also play a role—if a plan can report on one measure, it's likely able to report on the other. Notably, this correlation has increased from 0.71 in RY2023.
• Adherence Measures: Historically, adherence measures have been tightly linked, likely due to robust processes around retail-to-mail prescription adoption and generic drug utilization. This year, however, the correlation between anti-hypertensives and statins is 0.73, while anti-diabetes medications and statins only show a correlation of 0.51. This discrepancy suggests unique challenges in diabetes management.
• Diabetes as a Bellwether: Blood sugar control stands out, showing correlations above 0.60 with diabetic eye exams, blood pressure control, and medication reviews for older adults. This highlights the importance of integrated clinical care for diabetic members, as these measures represent a significant opportunity to earn points. Curiously, adherence to anti-diabetes medications is only weakly correlated (0.20), underscoring the need for pharmacy and clinical teams to collaborate more closely.
• Transitions of Care and Medication Reconciliation: These two measures align strongly (0.74), likely reflecting effective communication and data sharing between hospitals, care management, and providers. However, there's almost no link (0.04) between transitions of care and the CAHPS measure for getting care quickly. Since CAHPS surveys a small subset of members, their perceptions may not align with transitions in care, though intuitively, one might expect access to be more influential.
• CAHPS Measures: Interestingly, none of the CAHPS measures exhibit a correlation greater than 0.08 with other measures. This means that improvements in one CAHPS domain have little impact on others—a disappointing reality given the potential points at stake.

Strategic Takeaways

So, what actions should organizations prioritize to drive Stars improvement?

• Push Interoperability and Data Sharing: Building strong data connections lays the groundwork for closing care gaps and streamlining transitions.
• Integrate Pharmacy and Clinical Operations: Especially for conditions like diabetes, closer teamwork can help bridge the gap between medication adherence and clinical outcomes.
• Focus on Targeted Populations: Intensifying efforts in the care of specific groups, such as those with diabetes, can yield outsized returns.

With these insights, healthcare leaders can make informed decisions about where to invest for the greatest impact on CMS Stars scores in 2026. By prioritizing interoperability, integration, and targeted care, organizations can maximize their resources and deliver better outcomes for their members.