For Medicare Advantage plans, Star Ratings are oxygen. They influence bonus payments, rebate levels, enrollment growth, competitive positioning, and long-term sustainability. Yet each year, the bar moves higher: more member touchpoints, more measures, more scrutiny, and less room for operational inconsistency.
Plans rarely fail at Stars because of one catastrophic misstep. They fail because small operational gaps accumulate, member experiences become unpredictable, and teams spend more time reacting than preventing.
But the opposite is also true: when plans implement the foundational best practices that strengthen operations, member experience, and clinical outcomes at the same time, Star performance improves — sometimes dramatically.
Here are the five best practices that top-performing Medicare Advantage plans are using to protect (and grow) their Star Ratings in 2026.
1. Move From Reactive to Predictive Member Experience Management
Most plans still manage CAHPS and member-experience measures reactively. By the time a poor score appears, the damage is done. The best-performing plans treat member-experience improvement as a year-round operational discipline — not an annual clean-up effort.
Predictive experience management means understanding rising friction before it becomes a CAHPS response:
When members call multiple times for the same issue, it signals dissatisfaction long before it shows up in surveys.
When PA decisions take too long, members feel stuck in the system.
When eligibility updates or benefit clarifications lag, members perceive the plan as disorganized.
When provider data is outdated, members lose trust instantly.
Predictive plans monitor these signals daily, not quarterly. They identify “experience risk zones” and intervene early. For example, if a member has an unresolved issue for more than 72 hours, they proactively reach out. If a large portion of inquiries relate to a single benefit, they streamline the explanation or update provider communications. If PA delays are spiking, they reinforce workflows before grievances escalate.
The plans that excel at Stars treat member experience not as a customer-service function, but as an enterprise performance indicator.
Many plans are using Magical’s AI employees to automate experience-killing workflows — like status checks, benefit lookups, and case-file assembly — reducing friction at the moments members care most.
2. Compress Turnaround Times Across High-Impact Operational Workflows
The fastest-growing threat to Stars isn’t clinical outcomes — it’s administrative lag. Members increasingly expect same-day clarity, faster decisions, and fewer handoffs. And CMS now penalizes slow processes more explicitly.
Delays in areas like prior authorization, case resolution, provider lookup accuracy, and pharmacy exceptions directly affect CAHPS, complaints, grievances, and access measures. These delays, even if unintended, create the perception that the plan is difficult to work with.
Reducing administrative friction has become one of the most reliable ways to raise Stars performance:
Faster authorization decisions reduce member complaints.
Faster claims adjustments reduce provider abrasion, which trickles down to member experience.
Faster case resolution reduces grievances.
Faster benefit verification reduces call-center escalation.
Faster onboarding ensures members understand their benefits before issues arise.
The challenge is that Medicare Advantage plans don’t just need “some” speed — they need speed without sacrificing consistency or compliance. That’s where automation is increasingly playing a central role.
Instead of hiring more people, high-performing plans automate the repetitive connective tasks — document retrieval, status checks, portal navigation, data entry — allowing humans to focus solely on judgment, review, and communication.
Speed doesn’t come from working harder. It comes from removing the steps that slow teams down.
3. Build a Real-Time Provider Data Infrastructure (Not a Periodic One)
Provider data accuracy is one of the least glamorous Stars levers — yet it is one of the most financially consequential.
An outdated directory triggers:
access issues
higher-cost settings of care
inappropriate denials that frustrate members
incorrect attribution
grievances and appeals
regulatory penalties
complaints that directly reduce Stars
But the most overlooked consequence is that inaccurate provider data destabilizes almost every downstream Stars measure. Members can’t schedule care, can’t find in-network specialists, and lose trust in the plan. Delayed access to care then affects outcomes, experience, and compliance simultaneously.
The best-performing plans treat provider data as an always-on operational workflow, not a monthly or quarterly cleanup.
They:
monitor directory accuracy continuously
validate taxonomies, credentials, and affiliations in near real time
update network status proactively
resolve mismatches before they ever affect a member
This approach dramatically reduces complaints, improves access measures, and prevents the avoidable friction that tank CAHPS scores.
In 2026, accuracy isn’t enough. Speed and consistency are now core competitive differentiators.
Magical is often deployed by payers specifically to automate provider-data updates across portals and directories — eliminating the manual backlog that leads to member frustration.
4. Strengthen Medication Adherence Through Operational Precision, Not Additional Outreach
Medication-adherence measures (statins, diabetes, hypertension) are among the most influential in Stars weighting. Many plans respond with outreach programs, reminder calls, and targeted campaigns. Those are valuable — but they’re not the root cause of poor adherence.
Low adherence is usually the downstream effect of operational failure:
members unable to get refills approved on time
PA delays causing medication interruptions
wrong pharmacy information in the system
inaccurate formulary explanations
documentation mismatches preventing processing
member confusion about cost or coverage
physicians receiving unclear information from the plan
When these issues persist, adherence tanks — not because members don’t want their medication, but because the system makes it hard to stay consistent.
The highest-performing plans improve adherence by tightening the workflows behind it:
fast-turnaround PA for chronic conditions
automated refill verification workflows
proactive reminder systems tied to benefit design
cleaner data shared between providers and pharmacies
real-time eligibility checks to guarantee accurate cost at the counter
Plans that excel here treat adherence as an operational reliability problem, not a communications problem.
The result? Adherence rises without increasing member outreach costs.
5. Integrate Automation to Reduce Variability and Protect Quality Measures
Star Ratings reward consistency. Members shouldn’t have wildly different experiences depending on which staff member answers a call, or which queue their authorization request lands in.
Yet variability is rampant inside most payer workflows — different interpretations of guidelines, different timing, different documentation practices, different routing logic.
The plans that outperform their peers use automation to eliminate operational variance:
every PA request is assembled the same way
every benefit lookup follows the same steps
every case file contains the same structured information
every claims discrepancy is triaged consistently
every provider-data change is validated against the same rules
When processes run the same way every time, three things happen:
Member experience becomes predictably better.
Quality measures stabilize.
Complaints, grievances, and escalations drop.
Automation is how payers create predictable performance — not because machines are replacing people, but because machines prevent the small operational mistakes that compound into large Stars penalties.
Magical’s agentic AI employees are designed for exactly this: running multi-step workflows across portals and systems with zero deviation, improving consistency across Stars-critical processes.
Why These Best Practices Matter More in 2026 Than Ever Before
CMS is tightening timelines, increasing penalties, boosting the weight of experience measures, and raising expectations around operational integrity. At the same time:
utilization pressures are climbing
staffing shortages are ongoing
provider networks are consolidating
medical-cost pressure is rising
member expectations resemble consumer apps
The plans that succeed will be those that remove friction faster than CMS introduces new requirements.
Star Ratings in 2026 are no longer won through clinical care alone. They’re won in the workflows that determine whether members trust the plan, whether they can access care without obstacles, and whether their interactions feel seamless.
And those workflows are exactly where automation delivers the biggest lift.
Conclusion: Improving Star Ratings Starts With Fixing the Work Behind the Measures
Great Stars performance doesn’t come from chasing scores. It comes from strengthening the operational foundations that drive those scores.
Plans that focus on these five best practices will see meaningful improvement:
Predictive member-experience management
Faster operational turnaround times
Real-time provider-data accuracy
Operationally driven medication adherence
Automation to eliminate workflow variability
Do these things well, and Stars improve naturally — because members experience fewer obstacles, clinicians face fewer delays, and internal teams operate with far more consistency and speed.
The plans that lead in 2026 will be the ones that don’t treat Stars as an annual event, but as a year-round operational discipline supported by intelligent automation.
Want help identifying which Stars-critical workflows your plan can automate now?
Magical can run a quick analysis of your highest-volume workflows and show where agentic AI employees can reduce friction, improve consistency, and boost the operational metrics that influence Stars — all without integrations.