Estimating Unmitigated Impact of CY26 Star Ratings Recalculations; Reit OW ALHC, CVS, UNH

Research evidence excerpt

Estimating Unmitigated Impact of CY26 Star Ratings Recalculations; Reit OW ALHC, CVS, UNH

ere recalculations degrade Star Ratings, contracts

can remain at initial CY26 Star Ratings levels and retain associated CY27 QBP status.

• Our work suggests that recalculation would only increase CY26 Star Ratings for

29 contracts covering 913.12K lives or approximately 2.55% of the MA market. See

Exhibit 21. Absent CMS' hold harmless provision, we estimate that recalculation would

lower the overall MA market's enrollment weighted average CY26 Star Rating by (0.34)

from an initial 4.03 to a revised 3.69. Our initial 4.03 weighted average CY26 Star Rating

is approximately in-line with the 3.98 reported by CMS on the CY26 Star Ratings Fact

Sheet. We use each contract's initial CY26 Part C measure scores, Part C measure

weights, Part C CAI category, Part C CAI value and Part C summary rating to estimate its

initial CY26 Part C reward factor. Excel available on request. To recalculate CY26 Star

Ratings, we remove the 18 measures described in the HPMS memo (and listed in Exhibit

8); apply unchanged weights to the surviving Part C measures; assume initial CY26

Part C CAI category is unchanged; apply the new CAI value that corresponds to initial

category; add the contract's initial CY26E Part C reward factor; and round according

to CMS rules. We arrive at adjusted CY26E Star Ratings by contract. We compare

each contract's adjusted CY26E Star Ratings (contemplating only Part C measures,

adjustments and rewards) to its initial CY26 Star Rating (contemplating Parts C and D

measures, adjustments and rewards).

• We expect most ALHC, CVS, HUM and UNH contracts to remain at initial CY26

Star Ratings and retain associated CY27 QBP status. We estimate the unmitigated