2025 CMS Star Ratings Results: Inovalon’s Customers Shine Bright Among Falling Stars

Analysis of Inovalon customer performance versus the market for 2025 CMS Star Ratings results

The Centers for Medicare & Medicaid Services (CMS) released the 2025 CMS Star Ratings results for Medicare Advantage (MA) and Prescription Drug Plans (PDP), and trends are emerging.

Overall, the 2025 plan performance had a star rating decline of 0.12 from the 2024 ratings.¹ This outcome was unsurprising, given the changes in cut point methodology introduced for the 2025 star ratings.

In particular, introducing the Tukey Outlier Deletion Method, more commonly known as the Tukey method, led to a decrease in average star ratings for health plans across the nation and performance on many clinical measures going back to pre-pandemic performance.

While lower CMS star ratings results were mainly seen across the board, Inovalon customers using Converged Quality with Managed Services were a bright spot. Plans realized a 5% higher rating than the national average, marking a significant achievement in their performance in a year when most plans saw a dramatic fall in their ratings.

Four of the only seven (57%) health plans that achieved the highest 5-star MA rating use Inovalon's quality software.² In 2025, 12.5 million Medicare beneficiaries, representing nearly 40% of all MA enrollment, were processed using one or more of Inovalon's Converged Quality SaaS products to produce regulatory clinical measure rates, prospective reporting for quality improvement activities, star predictive cut point forecasting, or Medicare prospective benchmarks. Inovalon helps customers address quality measure gaps, contributing to their above-average performance by providing timely insights into measurement performance throughout the year, analytically driven intervention planning and prioritization, and patient-specific intervention outreach informed by industry-leading subject matter expertise.

Health plans supported by Inovalon's services have outperformed the market in measure performance year-over-year on key clinical and administrative measures, including a 4% measure rate increase for the Care for Older Adults measure Pain Screening indicator (COA-3); 8.7% higher for Follow-Up After Emergency Department Visit for People with High-Risk Multiple Chronic Conditions (FMC). For the Transitions of Care (TRC) measure, Inovalon customers realized an average 26.6% improvement from last year's ratings period. One of the most notable changes was on the Medication Adherence for Diabetes (MAD) measure; while most MA contracts reported close to a 5% decrease in 2025, Inovalon customers performed better by 5% year-over-year.²

Timely and actionable insights into measure performance throughout the year, analytically driven intervention planning and prioritization, and patient-specific intervention outreach helped these plans address quality measure gaps during the 2023 measurement year, contributing to their above-average performance improvement for 2025 CMS Star Ratings.

Impact of methodology and cut point changes on 2025 CMS Star Rating performance

Issued annually each fall, MA star ratings were created to provide healthcare beneficiaries with information to help them choose quality health plans. CMS utilizes a range of data sources to assign star ratings - including data from health plans, patient surveys, including the Consumer Assessment of Healthcare Providers and Systems (CAHPS) and the Health Outcomes Survey (HOS), and data from CMS contractors.

Across contract types, the 2025 Star Ratings include a maximum of nine domains comprised of a maximum of 30 measures. The contract types are:

• MA-Only contracts are measured on five domains with a maximum of 30 measures
• PDP contractsare measured on four domains with a maximum of 12 measures
• Medicare Advantage Prescription Drug (MA-PD) contractsare measured on all nine domains with a maximum of 42 measures, 40 of which are unique measures

In 2025, the average plan star rating decreased from 4.07 in 2024 to 3.92. This downward trend is due to changes in cut point methodology and higher performance on many clinical measures compared to their pre-pandemic performance. The percentage of MA plans with 4+ stars decreased from 32% in 2024 to 30% in 2025, which includes the total percentage of enrollees in 4+ star MA-PD plans dipped from 75% to 61%.²

Much of this downward trend is attributed to CMS introducing a methodology change in the last ratings period and subsequently recalculating rating after significant industry pushback and lawsuits from introducing the Tukey method, which was used for identifying outliers. Inovalon has been at the forefront of determining how these changes impact ratings and giving its customers an early look at the impacts; the company's forecasted cut point analysis demonstrated more than 95% accuracy when compared with CMS-released cut points for the last three consecutive years.

Methodology changes

MA plans must adapt to the CMS Star Ratings methodology changes each year, and 2025 was no different. The most significant update impacting health plan performance was the introduction - or the actual implementation - of the Tukey method for cut points. However, it wasn't the only change. Other notable changes in the 2025 CMS Star Ratings methodology included:

• 2025 cut points being baselined off newly reported 2024 performance, as the prior year ratings were recalculated this summer after the successful lawsuits of SCAN Health Plan, Zing Health, and Elevance Health
• The weighting of the Plan All-Cause Readmission measure increased to a triple-weighted measure
• The Controlling Blood Pressure (CBP) measure is considered new, and the guardrails did not apply
• The Medicare Plan Finder measure will have guardrails applied

The four weighting for patient experience and access measures reflects the higher emphasis CMS has on these areas and is a likely contributor to the lower performance seen in the 2023 and 2024 ratings. In particular, patient experience measures can be challenging for health plans to move the needle on as they are based on patient-reported outcomes through surveys like CAHPS.

Measure-level cut points

In addition to the Tukey method, there have been guardrails in place since the 2023 star ratings that apply to all non-CAHPS and non-improvement measures that have been in the Medicare Part C (MA) and Part D (PCP) star ratings program for more than three years. These guardrails limit cut point movement - up or down - to no more than five percent.

For 2026 and going forward, plans can expect more limited cut point movement for established measures, even if plan performance warrants a more significant shift.

Looking ahead to 2026 CMS Star Ratings

It's never too early to prepare for next year's star ratings. For 2026 and beyond, MA plans should keep in mind the following changes:

• The Controlling Blood Pressure (CBP) measure completed its third year of guardrail immunity; therefore, guardrails will be applied starting for the 2026 rating year
• The Colorectal Cancer Screening measure will transition from a traditional HEDIS^® Hybrid measure to a HEDIS ECDS measure. The measure methodology will no longer allow for the representative sampling used to report on a subset of the population through medical record review methodology; instead, the entire Medicare population eligible for the screening will be reported on. Inovalon benchmarking shows a significant drop in performance based on this methodology change
• Reductions in the weight of patient experience/complaints measures decreasing from four to two
• Kidney Health Evaluation for Patients with Diabetes (KED), a display measure for RY2025, is returning as an official administrative measure starting RY2026. This change will activate guardrail immunity for three years. The same is true for the Improving or Maintaining Physical Health (IPH) measure
• Improving or Maintaining Mental Health (IMH), also a display measure for RY2025, is added back as an official CMS measure starting RY2026. IMH/IPH will begin with a weight of 1 for RY2026 and move to a weight of 3 for RY2027
• Starting RY2027, the Health Equity Index (HEI) reward will replace the current reward, and if the HEI score is more than zero, it will uplift the plan's overall star rating. The current reward focuses on rewarding overall performance and consistency between individual measures. HEI will reward contracts that have a meaningful impact on at-risk beneficiaries, i.e., better outcomes for members with social risk factors than their peers

For lower-performing MA plans, those with access to comprehensive data sources and predictive forecasting will be best equipped to adapt to upcoming changes.

Achieve your quality improvement goals with Inovalon

Inovalon enables quality measurement activities for more than 100 health plans annually with our Converged Quality cloud solution, which processes nearly 192 million lives for quality reporting purposes, including more than 80%+ of all NCQA-covered lives.³

Contact us to schedule a demo and learn how Inovalon can help you achieve quality excellence.

¹ "2025 Medicare Advantage and Part D Star Ratings," Centers for Medicare & Medicaid Services, October 10, 2024, https://www.cms.gov/newsroom/fact-sheets/2025-medicare-advantage-and-part-d-star-ratings

² "Inovalon's Converged Quality Customers Realized a 5% Increase in Star Ratings Score, Including Nearly 60% of All Medicare Health Plans Which Received CMS' Highest 5-Star Rating," Inovalon, October, 31, 2024, https://www.inovalon.com/news/inovalons-converged-quality-solution-customers-realized-a-5-increase-in-star-ratings-score-including-nearly-60-of-all-medicare-health-plans-which-received-cms-highest-5-star-rating/

³ Inovalon calculation based on HEDIS® MY2022 data. September 2023.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Inovalon and design®, Inovalon®, and the Inovalon ONE® Platform are trademarks of Inovalon, Inc.

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