Medication adherence measurement is evolving, and so must the strategies health plans use to address it. CMS, in partnership with PQA, is implementing risk adjustment for the three PDC adherence Star measures (diabetes, hypertension, and cholesterol), using five sociodemographic factors (age, gender, dual eligibility, LIS status, and disability) to level the playing field for plans serving more vulnerable populations. The methodology compares a plan's observed adherence rate against a statistically modeled expected rate, anchored to a contract-type benchmark, so performance reflects care quality rather than member complexity. Alongside risk adjustment, stratification gives plans visibility into exactly where adherence gaps exist across subpopulations. Together, these tools point toward a clear operational shift: away from uniform outreach and toward barrier-resolution strategies that match interventions to the social determinants actually driving missed refills. With adherence returning to triple weighting in Rating Year 2029, plans that build equity-driven, risk-aligned outreach strategies now will be the ones best positioned to perform.

Catherine Hensley recently joined fellow healthcare leaders on a panel at the Becker's Conference to tackle one of the industry's most pressing challenges: closing the gap between what we know clinically about patients and how that intelligence actually shapes insurance design, benefits strategy, and care management.

CMS’s CY2027 proposed rule signals a major Stars Ratings shift away from administrative checkboxes and toward real clinical outcomes and patient experience—making true member health impact the new driver of success.