Improving Medicare Advantage Star Ratings requires more than increasing outreach volume or resolving member inquiries faster. Health plans must demonstrate performance against specific quality measures, including medication adherence, preventive care, access to services, and member experience.
According to the Centers for Medicare & Medicaid Services (CMS), approximately 37% of Medicare Advantage prescription drug (MA-PD) contracts—188 contracts—earned four stars or higher for 2027. When weighted by enrollment, approximately 71% of MA-PD enrollees were in contracts receiving at least four stars.
These ratings also have financial implications. CMS confirms that the 2027 Star Ratings will affect 2028 Medicare Advantage Quality Bonus Payments.
For health plans, the challenge is translating quality improvement priorities into consistent, measurable action.
Healthcare business process outsourcing (BPO) can support that effort through member outreach, appointment coordination, medication adherence reminders, documentation, and issue escalation.
However, outsourcing does not independently determine CMS Star Ratings. Its contribution depends on whether operational activities lead to verified results under applicable measure specifications.
Understanding that distinction is essential when developing an effective Medicare Advantage quality improvement strategy.
Medicare Advantage Performance Snapshot
Medicare Advantage Prescription Drug (MA-PD) Contracts
MA-PD Contracts
Received 4 Stars or Higher
188 Contracts
MA-PD Enrollees
In Contracts Rated 4+ Stars
Enrollment-Weighted
Why It Matters:
2027 Star Ratings affect 2028 Medicare Advantage Quality Bonus Payments.
Which Medicare Advantage Star Ratings Measures Can Outsourcing Support?
CMS evaluates Medicare Advantage and Part D contracts using measures related to clinical quality, medication use, patient experience, access, and operational performance.
Not every measure can be influenced through outsourced member engagement. Some depend primarily on clinical decisions, pharmacy claims, documented care, or member-reported experiences.
The relevant question is not simply whether a BPO can make more calls. It is whether the outsourced activity helps remove barriers to a measurable quality outcome.
The following examples illustrate where non-clinical support may contribute.
| Quality area | Relevant CMS measures in the 2027 ratings | Potential BPO contribution |
|---|---|---|
| Medication adherence | Medication Adherence for Diabetes Medications, Hypertension (RAS antagonists), and Cholesterol (Statins) | Refill reminders, barrier identification, and pharmacy coordination |
| Preventive screening | Breast Cancer Screening and Colorectal Cancer Screening | Eligibility-based outreach, appointment assistance, and follow-up coordination |
| Member experience | Getting Needed Care, Getting Appointments and Care Quickly, and Care Coordination | Benefits navigation, scheduling support, and issue escalation |
| Complaint handling | Complaints about the Health/Drug Plan | Accurate intake, routing, and documentation, subject to forthcoming measure removal |
These relationships should not be interpreted as direct cause-and-effect guarantees.
For example, completing a medication reminder call does not establish that a member met an adherence threshold. Similarly, arranging a screening appointment does not demonstrate that the screening was completed.
The plan must validate the relevant outcomes using the applicable CMS methodology and data sources.
How Outsourced Member Support Can Contribute to Quality Outcomes
The greatest potential value of healthcare outsourcing lies in consistent execution, appropriate escalation, and reliable documentation.
Three operational areas illustrate this contribution.
1. Supporting Medication Adherence Through Targeted Member Outreach
Medication adherence remains an important component of Medicare Part D quality measurement.
The 2027 Star Ratings include adherence measures for diabetes medications, hypertension medications involving renin-angiotensin system antagonists, and cholesterol medications involving statins.
Members may encounter several practical barriers to maintaining prescribed treatment, including refill difficulties, transportation limitations, uncertainty about coverage, or problems contacting their pharmacy.
Outsourced support teams can help health plans address these barriers through structured, plan-approved outreach.
Activities may include:
- Contacting members identified through payer-approved adherence programs.
- Providing reminders about prescription refills.
- Identifying member-reported obstacles to obtaining medication.
- Coordinating with pharmacies or designated plan resources.
- Escalating clinical questions to qualified healthcare professionals.
- Recording outreach results and unresolved barriers.
The distinction between outreach activity and measured adherence is critical.
A member who confirms receiving a reminder has not necessarily obtained the medication. CMS adherence measures rely on defined methodologies, including prescription claims-based proportion of days covered calculations.
Therefore, the effectiveness of an outsourced outreach program should be assessed against validated adherence data, not simply completed-call totals.
A reliable program connects member engagement records with plan-side performance monitoring while maintaining appropriate boundaries between non-clinical support and clinical decision-making.
2. Helping Medicare Advantage Plans Address Preventive Care Gaps
Preventive care programs frequently require outreach to members who may be overdue for recommended services.
Measures such as Breast Cancer Screening and Colorectal Cancer Screening illustrate why effective coordination matters.
A health plan may identify eligible members through its quality management systems, yet outreach alone does not guarantee that those members receive the recommended services.
BPO teams can provide administrative support by contacting eligible members, explaining available scheduling resources, assisting with appointments, and documenting reported barriers.
Consider a member identified as overdue for colorectal cancer screening.
An outreach representative may contact the member, provide plan-approved information about available screening options, and help coordinate an appointment or referral.
If the member reports a transportation or scheduling barrier, the representative can document the issue and direct it to the appropriate plan resource.
However, scheduling support is only one stage of the process.
The plan must still determine whether the qualifying screening occurred and whether sufficient evidence exists to satisfy the applicable measure specifications.
This creates three separate performance indicators:
Outreach completion: Was the eligible member contacted?
Service coordination: Was the member assisted with the next appropriate action?
Verified care completion: Does the plan have qualifying evidence that the required service occurred?
Treating these indicators separately helps prevent outreach programs from overstating their contribution to quality improvement.
3. Improving Member Access and Care Coordination
Member experience is another area where support operations can influence the interactions that shape a beneficiary’s experience with a health plan.
The 2027 CMS measure set includes Getting Needed Care, Getting Appointments and Care Quickly, and Care Coordination.
These measures assess member experiences or aspects of care delivery that extend beyond contact center performance.
A member may contact a health plan because they cannot locate an in-network specialist, understand a coverage requirement, or coordinate services following an appointment.
An effective support interaction may help clarify the next step, connect the member to an appropriate resource, or escalate an unresolved access issue.
For Medicare Advantage plans, outsourced support teams can assist with:
- Explaining covered benefits using approved information.
- Helping members navigate provider-network resources.
- Supporting appointment coordination.
- Routing unresolved access concerns to responsible teams.
- Documenting recurring member-service barriers.
These activities can support the broader member experience strategy, but contact center metrics and CMS survey outcomes must remain distinct.
For example, first-contact resolution measures whether an inquiry is resolved during the initial interaction under the organization’s definition. It is not equivalent to a CAHPS score.
Likewise, a higher internal customer satisfaction score does not automatically establish an improvement in CMS-rated member experience.
Health plans should use operational reporting to identify service gaps while evaluating official member-experience measures independently.
What the 2028 and 2029 Star Ratings Changes Mean for Outsourcing
Medicare Advantage quality improvement programs must also account for upcoming changes to the CMS measure set.
In its April 2026 Contract Year 2027 final rule, CMS finalized the removal of several administrative, operational, and other measures from future Star Ratings.
The changes include:
| Effective Star Ratings year | Measures scheduled for removal |
|---|---|
| 2028 | Call Center—Foreign Language Interpreter and TTY Availability, Parts C and D |
| 2029 | Customer Service, Part C |
| 2029 | Rating of Health Care Quality, Part C |
| 2029 | Complaints about the Health/Drug Plan, Parts C and D |
| 2029 | Certain appeals-related measures |
CMS is also adding a Depression Screening and Follow-Up measure beginning with measurement year 2027, affecting the 2029 Star Ratings.
These changes shift emphasis within the ratings framework toward clinical care, outcomes, and measures that better distinguish plan performance.
They do not mean that member service, language accessibility, complaints, or appeals management are no longer important.
For example, removing the complaints measure from Star Ratings does not eliminate CMS oversight of complaints or the responsibility of Medicare Advantage organizations to handle them appropriately.
Similarly, eliminating a call center availability measure from the ratings calculation does not remove applicable language-access and accessibility obligations.
For healthcare outsourcing programs, the practical implication is clear: operational goals should be aligned with the measures that remain applicable while continuing to meet broader service and compliance requirements.
CMS Contract Year 2027 Medicare Advantage and Part D Final Rule.
How Should Health Plans Measure a BPO Partner’s Contribution?
An outsourcing program should be evaluated on more than staffing capacity, call volume, or average handling time.
Those indicators can describe operational efficiency, but they do not establish improvement in Medicare Advantage quality measures.
A stronger evaluation framework separates activities the BPO controls from downstream outcomes that require additional verification.
Establish Operational Performance Indicators
Health plans can monitor indicators such as:
- Percentage of eligible members successfully contacted.
- Completion rates for planned outreach activities.
- Appointment coordination and follow-up completion.
- Accuracy of outreach documentation.
- Timeliness of unresolved-case escalation.
- Quality assurance results for member interactions.
These metrics help determine whether the outsourced process operates reliably.
However, they are not substitutes for official CMS performance data.
Connect Activity Reporting With Verified Outcomes
Consider a hypothetical medication adherence outreach program.
A BPO contacts members identified by the health plan as needing additional support. Agents document whether members were reached, whether a refill barrier was reported, and whether escalation was necessary.
The BPO can report these activities.
The health plan, using its authorized pharmacy and quality reporting data, can subsequently evaluate whether adherence performance changed for the relevant eligible population.
The two datasets answer different questions.
The BPO reporting demonstrates whether the intervention was delivered. The plan’s quality data indicates whether the measured outcome occurred.
Even when both improve, the plan should avoid assuming that outsourcing alone caused the change. Other interventions, population differences, pharmacy access, and measurement methodology may also affect performance.
Define Accountability Before the Program Begins
An effective operating agreement should establish responsibility for member targeting, approved communication scripts, documentation requirements, data security, clinical escalation, reporting, and outcome validation.
For example, the health plan may remain responsible for measure specifications, eligible-member identification, clinical governance, and official performance reporting.
The outsourcing partner may be accountable for authorized outreach execution, documentation accuracy, and agreed service-level performance.
This separation creates a more transparent basis for evaluating operational contribution without attributing every quality outcome to the contact center.
How Ameridial Supports Medicare Advantage Quality Programs
For Medicare Advantage organizations, outsourcing should extend existing quality strategies rather than replace plan-level clinical and regulatory responsibilities.
Ameridial’s Quality Programs Support services include HEDIS gap closure outreach support, Star Ratings-related member engagement, CAHPS experience support, and quality measure tracking and coordination.
Ameridial also describes payer-focused teams, standardized outreach workflows, documentation support, and AI-enabled quality monitoring as part of its service offering.
These capabilities can be applied to non-clinical activities within payer-defined quality programs.
For example, a Medicare Advantage plan managing a preventive care outreach initiative may require coordinated member contact, documented follow-up, and escalation of unresolved barriers.
Ameridial’s role in such a program would be to support the authorized operational workflow, while the payer retains responsibility for measure interpretation, clinical determinations, and official quality reporting.
The value of this approach should be assessed through clear service-level commitments, reliable documentation, and verified outcomes rather than an assumed increase in Star Ratings.
For organizations evaluating their current programs, the priority is determining where member engagement activities require greater consistency, capacity, or accountability.
Building a More Accountable Medicare Advantage Quality Strategy
Healthcare outsourcing can support Medicare Advantage quality improvement by helping plans execute member outreach, address administrative barriers, coordinate follow-up activities, and maintain consistent documentation.
However, successful outreach is not the same as a verified quality outcome.
As CMS updates the Star Ratings framework, health plans need a more disciplined approach to connecting operational performance with measure-specific results.
That means identifying where non-clinical support can contribute, defining responsibility for each intervention, and validating outcomes through appropriate plan-level data.
The goal is not simply to make more member contacts. It is to make each relevant interaction part of a measurable, accountable quality improvement process.
Explore Medicare Advantage Quality Program Support With Ameridial
Strengthen the operational foundation of your Medicare Advantage quality initiatives with structured member engagement, outreach coordination, and documentation support.
