Skip to main content
Request a demo

How Health Outcome Surveys will play a crucial role in 2026 and beyond

As the landscape of Medicare Advantage (MA) Star Ratings evolves, the integration of the Health Outcomes Survey (HOS) measures into the Star Rating system is becoming a crucial factor in healthcare systems. To optimize your health plan's performance for the upcoming changes to 2026 and 2027 Star Ratings, it's critical to understand the impact of Health Outcomes Surveys. By analyzing HOS data and identifying areas for improvement, you can effectively address member pain points and drive higher ratings.

The HOS evolution: Key changes to Medicare Advantage Star Ratings

The Centers for Medicare & Medicaid Services (CMS) has made a notable change to how HOS measures will factor into Star Ratings. And this will significantly impact how Medicare Advantage plans approach their performance metrics. Starting with the 2026 Star Ratings, two key HOS measures—“improving or maintaining physical health” and "improving or maintaining mental health”—will be fully integrated back into the stars program. These measures had previously been taken off the CMS display page due to the COVID-19 pandemic but are now returning with a weighting of a factor of one.

They will also be reintroduced as outcome-based measures with a weighting of 3 starting with the 2027 Star Ratings. This is an important shift, highlighting the growing importance of HOS as a direct influence on a health plan’s Star Rating. Understanding how to leverage this newly integrated metric will be a game-changer for plans looking to maximize performance.

Why Health Outcome Surveys matter

The HOS is more than a health risk assessment (HRA); it provides deeper insights into your members' health risks. A key challenge with the HOS is the time lag between collecting survey responses and using the data effectively. By the time HOS data is available, it’s often too late to act, making it difficult for plans to address emerging issues or trends.

To bridge this gap, Medicare Advantage plans must regularly monitor their members’ holistic health outcomes. By doing so, they can capture relevant, real-time data to guide performance on the HOS measures, ensuring that your plan is consistently working to improve members' physical and mental health. Conducting an HOS-like survey annually will provide valuable insights into your members’ behaviors and health.

How to conduct practice surveys and improve member engagement

Since Medicare Advantage plans must conduct an annual health risk assessment for each member, there’s an opportunity to align the HRA with the HOS for better results. Aligning your HRA with key HOS metrics helps you track emerging conditions and address care gaps before they escalate. Post-encounter surveys after doctor visits or care management can capture specific data tied to HOS measures. You can include questions about fall risk, urinary incontinence, and physical activity. These key indicators help identify health risks and provide valuable insights for future proactive outreach and care management.

Predictive modeling: A strategic tool to drive HOS performance

Another strategy that’s gaining significant traction among high-performing Medicare Advantage plans is predictive modeling. By analyzing multiple data sources, predictive models can be used to target specific member populations, increase engagement, and improve overall health outcomes.

Predictive modeling can help in several areas:

  • Predicting HOS response rates: One challenge with HOS surveys is identifying which members are likely to respond. But predictive models can detect members, helping you focus outreach efforts to increase response rates, improve survey completion, and boost Star Ratings.
  • Predicting healthcare engagement: Engagement with healthcare services is a key indicator of member health. Predictive models can highlight members likely to engage with outreach, so you can prioritize interventions for those at higher risk of health issues or non-response to surveys.
  • Targeting specific HOS and MCAHPS measures: By predicting how members are likely to score on specific HOS or Consumer Assessment of Healthcare Providers and Systems (MCAHPS) measures, predictive modeling can help direct limited resources where they will have the most impact. This lets you improve scores on measures that are most relevant to your plan’s overall star rating.
  • Identifying health risks: Predicting health risks using HRA data, social determinants of health (SDOH) indicators, and claims data can help plans take a proactive approach to care. By pinpointing members at risk for specific conditions, plans can offer tailored interventions that improve health outcomes and HOS scores.

Lessons learned from high-performing Medicare Advantage plans

Over the years, I’ve had the opportunity to work closely with high-performing Medicare Advantage plans. When I first began managing a Medicare Advantage Stars program, I reached out to plans with ratings near 5 stars and asked about the metrics they cared most about. Interestingly, many of them were primarily focused on the Healthcare Effectiveness Data and Information Set (HEDIS) measures and medication adherence. HOS and CAHPS measures were not included in that list, because these plans felt it was too difficult and resource-intensive to directly influence members’ responses to these surveys.

We began by capturing member health outcomes data through surveys using Interactive Voice Response (IVR) technology.  This approach lets us gauge how members would respond to the regulatory HOS survey, giving us a head start in addressing any gaps in care.

We followed up with a tailored outreach strategy, sending gap reports to primary care physicians to facilitate in-person discussions with members. These conversations helped close care gaps before the official regulatory HOS survey, ensuring issues were fresh in members' minds when they completed it. By conducting mock surveys 5–6 months earlier, we were able to make meaningful interventions that improved our survey results.

The future of mock HOS surveys: Digitalization and efficiency

Today, practice surveys are available through various digital platforms, including email, SMS/text, and IVR. These methods are not only more cost-effective than traditional phone or mail surveys, but they’re also quicker to administer, giving plans more flexibility and efficiency in gathering data to improve Star Ratings. With the window for conducting practice surveys opening in January, now is the time to start planning your strategy to administer these surveys.

Incorporating digital surveys into your outreach will ensure you collect the right data on time, so you can make more informed decisions that impact Star Ratings.

As CMS continues to evolve the Medicare Advantage Star Ratings, HOS measures will play a larger role in a plan’s success. By integrating HOS-like surveys into your annual health risk assessments, leveraging predictive modeling, and conducting mock surveys to close gaps, you’ll be well positioned to improve Star Ratings. The HOS measures represent a unique opportunity to engage with your members in meaningful ways, enhance their health outcomes, and ultimately strengthen your plan’s performance in the competitive Medicare Advantage landscape. 

Reach out to Press Ganey to plan ahead for the upcoming survey windows, and make sure your strategies are aligned with new CMS guidelines.  

About the author

David L. Larsen currently works as Senior Advisor Member Experience at Press Ganey and prior to that he worked as an independent healthcare consultant working with predictive analytics, member engagement, and pharma vendors to improve their offerings and sales approach to managed care plans and working with managed care plans to improve their Medicare Advantage Star Ratings focusing on improvements related to CAHPS, HOS, HEDIS, medication adherence, and member experience measures. David served as the Director of Quality Improvement for SelectHealth in Salt La­ke City, Utah for 32 years and worked for Intermountain Healthcare for 38 years. SelectHealth is a mixed model HMO with more than 950,000 members in Utah, Idaho, and Nevada across all insurance product lines including, Medicare Advantage, manage Medicaid, large, small, and individual commercial plans, and ACA plans. Intermountain Healthcare is an integrated health care delivery system with 23 hospitals and over 1,500 employed physicians. As the Director of Quality Improvement, David had responsibilities for oversight of the Medicare Advantage Stars program for which SelectHealth received a 5 Star rating in 2022, maintaining NCQA accreditation; HEDIS performance measurement and improvement; CAHPS and HOS measurement and improvement, public reporting (transparency), and population health. David has also been responsible for the oversight and development of chronic disease registries, performance measurement and web based reporting systems, quality improvement pay for performance incentives for providers, provider transparency programs, and direct patient improvement interventions related to chronic illnesses including patient adherence monitoring, reminders, and incentive programs.

Profile Photo of David Larsen