The Spotlight is Back on HEDIS for Stars

Andrew Bell

Senior Manager

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This is the time of year where all health plans are focusing on two Star Years (SY) at once. It is important that SY2025 is closed out strong, while simultaneously building the right strategy for SY2026. As we are already over three months into SY2026, the time is now to start focusing on the execution of your targeted interventions to support improvement within Stars specifically within The Healthcare Effectiveness Data and Information Set (HEDIS©). In previous years, the spotlight was on Member Experience driving most of the weighting but in SY2026 it will decrease to a 2x weight (previously 4x weight) making other domains such as HEDIS essential to drive performance.

SY2025 Closeout

The beginning of the calendar year means it is HEDIS/Medical Record Review season and within this timeframe; everyday matters, so make them count. With approximately a month left, health plans need to leverage their strategic provider partnerships and utilize data reporting and tracking to optimize opportunities for quality improvement (QI) and ultimately achieve their year-end Stars’ goal.

Leveraging provider partnerships: Now is the time to lean in on your plans’ relationship with providers who care for your members. Utilizing your previously developed provider repository, accessing provider group Electronic Medical Records (EMRs), and knowing when to escalate in areas needing additional support is key.

Data reporting and tracking: Real-time data updates regarding chart chase status, measure-level gap analysis/forecasting and identifying key opportunities for broad chart closure efforts are critical to ensuring a successful close-out to Hybrid season.

SY2026 Strategic Plan and Execution

As we enter a new Stars Year, it is critical that your plan is poised for success by setting clear and achievable goals. This year presents the opportunity to innovate and refine your plan’s approach, particularly with new interventions targeting both identified priorities and newly introduced measures. As we navigate the ever-evolving Stars landscape, it is key to maintain alignment across all areas of the organization to effectively adapt to industry changes and emerging trends. By fostering collaboration and strategic alignment, your plan can maximize its potential, achieve the goals set forward and make a meaningful impact on the health of your members.

Ensure your goals are set: Conduct goal setting activities to achieve your contract-level goals and establish priority measures that will have significant impact on your plans performance if the goals are achieved.

Develop new interventions for priority measures: Plans must look ahead and continue to be innovative with interventions, relying on what got you here will not get you to where you want. Develop key strategies around the priority measures to ensure continuous improvement is driven forward.

Alignment across the organization of industry changes for SY2026: Plans must understand how the industry is changing every year in Stars. With the weighting shifting away from member experience, success in HEDIS will be more necessary to drive a plan’s performance. Key changes for this SY are outlined below:

  • Addition of Kidney Health for Patients with Diabetes (1x weight)
    • Colorectal Cancer Screening removed from Hybrid Reporting - moved to Electronic Clinical Data Systems (ECDS)
    • Introduction of Health Equity Index – monitoring applicable HEDIS measures for Social Risk Factors

At ProspHire, we continue to partner with health plans, to offer insights, analysis and execution strategies to improve Star ratings. Do you need support developing the right SY2026 execution strategy? Let's have a conversation.

*NOTE: HEDIS© is a set of standardized performance measures developed by the National Committee for Quality Assurance (NCQA).