Health plans can no longer afford to rely on retrospective tools or delayed claims data. CMS is introducing more time-critical quality measures into Star Ratings to accelerate intervention velocity, reduce preventable readmissions, and improve outcomes. The limitations of manual workflows and claims-based approaches have become impossible to ignore. The future of Star Ratings lies in real-time detection, seamless collaboration, and technology-driven solutions that empower payers and providers to close care gaps while there's still time to act. 

Why Health IT Is Essential

Traditional approaches, relying on census and claims data, often result in a several week lag before patient status updates reach care teams. This delay is especially problematic for measures like TRC where notification of inpatient admission and discharge, which must be shared within just two days. Without timely insights, health plans struggle to meet these time-critical HEDIS and CMS requirements, resulting in lower Star Ratings and missed financial incentives. 

Real-time intelligence solutions address these challenges by: 

• Eliminating Data Lags: Real-time access to patient information enables immediate action on time-sensitive measures, such as transitions of care and medication reconciliation.  
• Facilitating Seamless Collaboration: Technology bridges the gap between payers and providers, allowing for instant sharing of critical alerts, status changes, and documentation across the care continuum. 
• Enabling Proactive Intervention: By streamlining workflows and improving data visibility, real-time care coordination solutions help health plans act during critical care transitions when members are most receptive to change, directly impacting multiple Star Ratings measures.

Key Capabilities of Modern Quality Operations

Solutions like Quality & Coding Management (QCM) are designed to optimize quality and performance metrics for health plans. Here’s how: 

• Real-Time Detection and Notification: Built-in HEDIS filters instantly flag denominator events within hours, not weeks, enabling care teams to spot critical care gaps the moment they open.

• Time-Critical Intelligence: Smart dashboards show exactly who to call, why to call, and how much time is left to act—turning data into actionable priorities with visible countdown timers.
• Actionable Workflows: Prioritized member lists ensure teams focus on the highest-impact interventions first, maximizing every care coordination opportunity during time-sensitive windows.
• Pre-Configured HEDIS Specifications: Built-in templates and tracking tools streamline provider follow-up and performance monitoring for members who require attention, reducing administrative burden and human error.

The Impact: From Compliance to Competitive Advantage

Real-time intelligence solutions aren’t just a compliance tool, they’re a strategic asset. Plans that embrace technology gain a competitive edge, with the ability to: 

• Secure higher Star Ratings, leading to increased enrollment, retention, and revenue

• Qualify for quality bonus payments and special enrollment periods
• Respond rapidly to regulatory changes and new quality measures
• Improve patient outcomes through timely, coordinated care 

Looking Ahead: The Future of Star Ratings

Time-sensitive HEDIS measures demand real-time action. Plans that invest in real-time visibility, clinical data exchange, and workflows built around proactive intervention will protect their Star Ratings in a landscape where CMS has made its priorities unmistakably clear. Don't settle for delayed signals. The path to better Star Ratings—and better patient care—runs through real-time intelligence that drives measurable results.
 
Ready to take your health plan’s performance to the next level? The future of Star Ratings is here, and it’s powered by collaboration, data and technology. Visit pointclickcare.com to learn more.