Answer first: Star Ratings and HEDIS improvement starts with the system behind the measures, not the measures themselves. Before we recommend a single intervention, we look at how the systems are built, how data moves, who owns the result, and how the plan manages its vendors and delegated relationships.
Most health plans do not have a Stars effort problem. They have smart teams working nights and weekends on the wrong part of the problem.
Why measure-by-measure work stalls
Gap lists, member campaigns, outreach, and chart retrieval are all useful tools. The trouble starts when they become the sole strategy. Working one measure at a time treats symptoms, although at times we must do it. Teams work hard, individual rates move a little, and the overall rating does not. The effort is real, the aim is off. That is when the long-term strategy needs a second look.
What we look at first
The whole rating, not one measure. Star Ratings blend clinical quality, member experience, pharmacy, and plan operations, and the measures do not carry equal weight. Improvement that ignores the full picture spends effort where it moves the rating least.
How data actually moves. A measure gap can be a care gap or a data gap. They look identical on a report and need completely different fixes. Sometimes we see data opportunities that are completely missed.
What the provider relationship rewards. Contracts and incentives shape what happens in the exam room long before any outreach call. We covered this in Your provider contracts are your HEDIS strategy.
What happens in the clinic. Workflow and documentation decide what the plan sees. Our clinical background matters most here.
Who owns the result. When everyone owns a piece of the rating, no one owns the rating.
How vendors and delegates perform. Outsourcing the work does not outsource the result. Vendors and delegated entities need clear expectations, real oversight, and accountability for what they deliver.
Where you are in the cycle. Stars results lag the work. Some levers move this year, some move next year, and some take longer. Matching the lever to the window is the difference between a plan and a scramble.
How success is measured. Activity counts look like progress. We tie the work to results.
None of these areas is a secret. What we do with them is where experience comes in: what we ask for, what we look for, and how we weigh what we find.
Why we start there
The fix depends on the cause. A plan that skips the diagnosis funds the wrong work, and because results lag, it can lose a full cycle before the data says so. Starting with the system takes a little longer at the front. It saves far more time at the back.
It also means we will not tell you that you are right until the evidence does. Sometimes it confirms what leadership believed. Sometimes it shows everyone was asking the wrong question. Either way, you are funding the right work.
What to do next
Before funding the next intervention, ask where the problem sits: care, data, contracts, clinic workflow, vendors, or ownership.
Look at the rating as a whole. Compare where your improvement dollars go with where the rating actually moves.
Name one owner for the overall Star Rating, not just for individual measures. Every bus needs a driver.
Map each initiative to the year it can realistically move results.
Hold vendors and delegates accountable to their SLAs.
Report results to leadership, not activity.
At Dueringer Advisors, we do not believe you hire consultants to tell you you're right. You hire us to help you get it right.
Frequently asked questions
Why haven't our Star Ratings improved after more member outreach?
Often because the gap was never a member behavior problem. If the cause is missing data, contract terms, or clinic workflow, more outreach may not close it.
Where should a health plan start when trying to improve Star Ratings?
With the whole rating and the system behind it: data, provider incentives, workflow, and ownership. Choose interventions after you know which layer the problem sits in. This is why an assessment comes first.
How long does Star Ratings improvement take?
Honestly, it usually takes years. Results lag the work, and some levers move faster than others, which is why timing belongs in the plan. We will not promise you 5 Stars in six months.
About the author
Tina M. Dueringer, BSN, RN, CCM, PCC, is CEO and Principal Advisor of Dueringer Advisors, Inc. About Tina