Let’s have a conversation
The Challenge: Navigating a Shifting Stars Landscape
Medicare Advantage plans are entering one of the most complex and high-stakes Stars cycles to date. As cut points tighten, new measures are added and a greater emphasis is placed on outcomes-based measures, plans are faced with the reality that every decision from governance design to resource allocation carries a lasting impact. Plans can no longer rely on reactive strategies or one-off improvement efforts. Sustained performance now requires foresight, alignment and deliberate planning across all levels of the organization.
What Successful Plans Are Doing Differently
Leading Medicare Advantage plans are shifting from short-term fixes to enterprise-wide Stars strategies that aligns product strategy, technology investment strategy and operational efficiency around sustained performance. These organizations focus on building accountability and clarity through governance structures, use predictive analytics to inform decision making and integrate real-time data to drive decision making at all levels.
As plans prepare for the 2026 measurement year, several priorities stand out:
Governance Optimization: Governance is basic but it is everything. Plans need to do more with less and that means they should be re-evaluating their current models. They need to seek transparent, accountable and cross-functional governance models that drive alignment and ownership across teams.
Align Product Strategy and Stars Strategy: This AEP has been one of the most hectic AEPs in MA history, with more plans exiting the market and reducing service areas than ever before. The gradual shift away from PPOs and toward HMOs is also telling. Plans need to take the opportunity to align current and future product strategies to Stars strategies to prepare for what’s coming in MA.
Stars Analytics and Forecasting: Analytics and forecasting capabilities are table stakes at this point in the Stars game. Plans need to apply those data-driven forecasts and existing competitive intelligence to stay ahead of regulatory changes and cut point shifts. Integrating Stars intelligence capabilities into network contracting, member engagement activities and business planning are a few of the many use cases of this type of data.
Performance Planning and Domain Expertise: Each domain from within Stars carries its own unique set of rules, nuances and minutia. Plans need expertise at the domain level to be able to connect what the data is telling them with the reality of operations on the ground.
Successful plans understand that Stars success is not just about closing gaps; it is about translating insights into coordinated action that drives measurable results year after year.
Our Perspective
At ProspHire, we have led Stars programs from the inside. Our advisory approach helps health plans move from reactive to deliberate, aligning leadership and operations around a shared vision for long-term success.
Think Ahead. Plan Differently.
The path to future Stars success begins with informed, strategic action today. Let’s plan differently for 2026, combining insight with execution and experience with results.
