Prepare for 2026: Key strategies for health plans to boost HEDIS and Star Ratings

Editor’s note: this is the first of a two-part series offering insight to what health plans need to know to make actionable decisions about member strategies that will positively impact HEDIS and Star Ratings.

It’s coming. HEDIS scores are set to carry more weight  in Star Ratings by 2026. With more than 227 million people currently enrolled in plans that report HEDIS results,¹  now is the time for health plans to optimize their approach to care management. HEDIS scores will soon make up 25% of the Star Ratings, compared to just 13% in 2023, highlighting the need for health plans to take proactive steps to enhance member outcomes and satisfaction.

But how to get started? Here are three critical strategies to prepare for these changes effectively:

Enhance integration for seamless care management

Integrating health education, member data, and engagement analytics into one platform is essential for efficient care management — and to make life easier for care managers. This approach simplifies workflows, giving them immediate access to health education tools that are personalized to each member’s needs. A centralized system also ensures that all members receive consistent, reliable information, making it easier to engage them and earn their trust.

Tailor programs to your member demographics

Effective engagement begins with understanding your member base. Use demographic data to shape care plans tailored to specific member populations. This personalization not only improves engagement but also aligns directly with HEDIS measures, ultimately leading to better outcomes and higher ratings. Personalized care plans can help members take proactive steps in managing and improving their health, an essential part of achieving HEDIS benchmarks.

Prioritize self-management tools for members

Digital tools that enable self-management, accessible anytime and  anywhere, are a powerful resource for members and health plans alike. According to recent data², members prefer digital healthcare solutions for managing various aspects of their care. By promoting self-management tools that are mobile-friendly and accessible, health plans empower members to take charge of their health, which is critical for both chronic condition management and preventive care.

Final thoughts

Changes to HEDIS scoring are coming, and 2026 will be here before you know it, so health plans should get started now.  Because members desire information about their health, you want to be prepared to give it to them and establish yourself as a highly-rated, member- centric business.

Ready to learn more? We have an entire white paper on implementing change and improving HEDIS scores. Check it out.

Sources

1. Five Health Plans Earn Five-Star Ratings From NCQA, Healthcare Innovation, https://www.hcinnovationgroup.com/population-health-management/payers-providers/news/55140408/five-health-plans-earn-five-star-ratings-from-ncqa
2. Next-generation member engagement during the care journey, McKinsey & Company,
   https://www.mckinsey.com/industries/healthcare/our-insights/next-generation-member-engagement-during-the-care-journey