The average Medicare Advantage Star rating for 2026 is basically flat–3.66 compared to 3.65 in 2025–with just over four in 10 Medicare Advantage contracts earning at least four out of five stars, the threshold to qualify for the maximum 5% bonus payment. CMS will distribute at least $12.7 billion in bonus payments this year. Those who don’t meet the four-star threshold miss out entirely on bonus funds, potentially leaving tens of millions of dollars on the table.
Why does it matter to Moxe whether health plans meet that four-star threshold?
This is where Moxe shines: providing near real-time access to the clinical data that’s needed to support quality measure performance. Having reliable, consistent access to the comprehensive medical record is essential for health plans to be able to close care gaps, improve HEDIS performance, and support value-based care.
While it may feel like you need an advanced math degree to understand just how Star ratings are calculated, one thing is clear: Outcome measures continue to be given more weight than other Star rating domains like patient access and member experience. In calculating the 2026 Star ratings, outcome measures were weighted three times that of administrative measures.
This is where Moxe shines: providing near real-time access to the clinical data that’s needed to support quality measure performance. Having reliable, consistent access to the comprehensive medical record is essential for health plans to be able to close care gaps, improve HEDIS performance, and support value-based care.
When a health plan needs to report on how many patients within a member subset have had breast or colorectal cancer screenings or flu shots, for example, Moxe delivers the complete patient chart directly from the EMR so all clinical data points like screenings, imaging results, lab values, and immunization records can be factored into quality measure reporting. Our tech-forward approach allows us to deliver data when, where, and in the format it’s needed, often dependent on whether people or natural language processing (NLP) will be doing the initial chart review.
Essentially, Moxe provides the foundation that’s needed for health plans to make gains in the quality measures that are heavily weighted in Star rating calculations.
A Vice President of a large national payer said of their experience partnering with us: “Operationally, we are receiving more data and reviewing it much more quickly than before. Financially, because we are reviewing more records, we are seeing a higher rate of return on chart reviews. We are getting comprehensive data, and we weren’t getting that previously.”
AmeriHealth Caritas saw similar results. In a case study for KLAS, they reported a 2 to 7% improvement in care-gap closure rates over nine-months working with Moxe and improved their ability to track and trend data for HEDIS measures.
Although providing reliable, consistent, timely access to clinical data is where Moxe can most directly impact Star ratings, better access to more complete clinical data has an undeniable trickle down effect. When chart retrieval is automated and clinical data delivered in the its most useful format, health plans can reallocate resources to other areas that can positively impact Star ratings, like patient experience and administrative processes.
We know health plans are in the thick of planning for HEDIS season. Because of the weight given to HEDIS performance, it’s critical that health plans are well prepared to deliver the data that’s needed to show their clinical outcomes in the best light.
We’d love to talk with you about how we can support you as you prepare for HEDIS season and ultimately set the stage for achieving the highest Star rating possible for 2027. If you are ready to see how Moxe can help improve the data you receive with our powerful and EHR-agnostic chart retrieval technology, schedule a meeting today.