The Final Rule is here, and no one is safe

Why access isn’t enough and what actually drives member experience

In this episode of Rising Stars, presented by Press Ganey, Mick Twomey and Jessica Assefa sit down with David Shapiro to unpack new data shaping the future of Medicare Advantage and health plan performance. At the center of the conversation is a critical insight: what looks like strong access on paper doesn’t always translate into real-world access for members. Coverage and network size may check the box—but when members can’t get care when they need it, the impact shows up quickly in experience, trust, and Stars performance. Together, they explore: * The growing gap between reported access and actual member experience * Why provider interactions and appointment availability are shaping performance earlier in the journey * The rise of member disruption, even when members don’t choose to switch How engagement signals can help predict outcomes and guide more targeted strategies This episode highlights a fundamental shift: the drivers of performance are moving upstream. Plans that understand what members actually experience, and act on those insights, will be better positioned to improve outcomes and sustain performance over time.

The Final Rule is here, and no one is safe

CMS’s final rule didn’t bring surprises, but it did raise the stakes. While most plans may not see immediate Star rating changes, the underlying math tells a different story: performance is shifting, and no one is in a safe zone. In this episode, Press Ganey’s Jessica Assefa and Mick Twomey break down what the rule really means, and why plans must move beyond measures to understand which members are driving performance. Key Themes & Takeaways: * The rule didn’t change much—but its impact is real * Most plans won’t move stars, but scores are declining * No plan is in the safe zone * Performance is shifting from measures to populations * Behavioral health and high-risk segments will drive outcomes

Beyond fire drills: Building a stronger Stars strategy for 2028 and beyond

As plans balance Star year 2027 performance with Star year 2028 planning, this episode tackles the operational realities of Stars strategy in real time. Jay Palmer, Medicare Advantage & Stars strategy executive, shares practical advice on member segmentation, provider collaboration, vendor governance, and cross-functional alignment, along with examples from her own experience leading quality programs. Press Ganey’s Jessica Assefa and Phil Collins also dig into what proposed measure changes could mean for future performance and why plans can no longer rely on the same last-minute tactics year after year. It’s a practical discussion for health plan leaders looking to build a more durable, member-centered Stars strategy. Key Themes & Takeaways: * Focus on the denominator, not just closing gaps. Understanding who your members are and why gaps exist leads to more effective, targeted interventions. * Act early to avoid year-end fire drills. Plans that use early data to guide strategy outperform those relying on last-minute outreach. * Alignment across teams, providers, and vendors is critical. Breaking down silos and improving coordination is one of the biggest drivers of Stars performance.

You don’t win Stars during survey season

In this episode of Rising Stars, Jessica Assefa and Phil Collins of Press Ganey unpack what health plans can still control right now, especially during HEDIS medical record review season, and why strategy matters more than effort. Guest LaTonya Augustine (Director of CAHPS & Stars Programs at Clever Care) shares how Clever Care sustained growth while improving Stars performance, including achieving 5 stars in both GSD and CBP. The conversation connects the “last levers” (hybrid chart chase, TTY/translation operations, vendor oversight, and CAHPS readiness) to a single throughline: member-first + provider-as-partner, executed prospectively and retrospectively with disciplined data capture. Topics include: * Maximizing hybrid HEDIS during chart chase * Owning controllable operational measures * Turning provider partnership into 5-star performance