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What are HEDIS measures and CMS Star Ratings?

Also called: Quality Measures (HEDIS & CMS Stars), HEDIS, Medicare Star Ratings

HEDIS is a widely used set of health plan performance measures maintained by the National Committee for Quality Assurance (NCQA). CMS Star Ratings score Medicare Advantage and Part D plans from one to five stars, partly using HEDIS results, and affect plans' bonus payments and enrollment.

By John Britton, VP of Marketing, MedicalProspects · Updated November 4, 2026 · Healthcare Organizations

Why it matters for healthcare sales and marketing

For health plans, better HEDIS results and higher Star Ratings mean more revenue and more members. Plans buy outreach, care gap closure, analytics and provider engagement programs to improve them, which makes quality leaders at health plans an important buyer group.

How it works

  • HEDIS: standardized measures of care, such as screenings and chronic condition management, reported by health plans.
  • Star Ratings: CMS's one-to-five star scores for Medicare Advantage and Part D plans, built from many measures including HEDIS, member surveys and operations data.
  • Why they matter: higher-rated Medicare Advantage plans can qualify for quality bonus payments and appear more attractive to members.
Flow from HEDIS measures plus member surveys and operations data into CMS Star Ratings, which affect bonus payments and enrollment.
HEDIS results feed into Star Ratings, which affect Medicare Advantage plans' bonuses and enrollment.

Example

Illustrative scenario. A care gap closure vendor targets quality and Stars leaders at Medicare Advantage plans, showing how its outreach improves specific HEDIS measures that feed into the plan's Star Rating.

Common mistakes

  • Confusing HEDIS with hospital measures. HEDIS is mainly for health plans.
  • Ignoring the measurement calendar. Plans plan improvement work around measurement years.
  • Pitching to providers only. Plans drive and fund much of this work.

Related terms

  • Payer vs ProviderIn healthcare, payers pay for care and providers deliver it. Payers include commercial health plans, Medicare, Medicaid and self-insured employers; providers include hospitals, physician practices, clinics and other care settings.
  • Value-Based CareValue-based care is a payment approach that rewards healthcare providers for the quality and cost of care rather than only the number of services they deliver, as in traditional fee-for-service.
  • MIPS and MACRAMACRA is the 2015 U.S. law that created Medicare's Quality Payment Program. Its main track, the Merit-based Incentive Payment System (MIPS), adjusts Medicare Part B payments to eligible clinicians up or down based on their performance on quality, cost, improvement activities and interoperability.

Put it to work

Sources

  1. HEDIS, NCQA
  2. Part C and D Performance Data, CMS

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