How Health Plans Are Using Content to Improve HEDIS and Star Ratings
Research Report by CARAVAN Wellness
Quality Ratings Have Never Mattered More
For Medicare Advantage plans, Star Ratings are not a reputational metric, they are a financial and operational reality that determines bonus eligibility, rebate percentages, and the ability to market year round. For commercial and Medicaid plans, HEDIS performance directly influences employer contract renewals, regulatory standing, and NCQA accreditation.
In 2025, the weighted average Star Rating across the largest Medicare Advantage plans fell to its lowest point since 2015, with only 1.8% of membership in a 5 Star plan, down from a peak of 27% in 2022 and 8% the prior year. The scale of that decline reshaped the competitive landscape almost overnight.
Plans that saw membership shift out of 4 Star and 5 Star tiers experienced direct margin pressure from the loss of quality bonus payments. The plans that held their ground, or improved, did so in part through deliberate, sustained investment in member engagement and education. Understanding what that looks like in practice is now a strategic priority for quality and population health leaders.
Understanding the HEDIS Stars Relationship
HEDIS (Healthcare Effectiveness Data and Information Set), managed by NCQA, is the primary measurement framework for health plan quality across commercial, Medicare, and Medicaid lines. Over 90% of U.S. health plans use HEDIS measures, making it the most widely adopted quality benchmarking system in the country.
Medicare Advantage Star Ratings, administered by CMS, incorporate HEDIS performance alongside member experience measures from the CAHPS survey, plan administration metrics, and health outcomes data. Improving HEDIS scores is therefore a direct input to improving Star Ratings, and the financial consequences of a single rating increment are substantial. A half Star increase in Star Ratings is valued at an estimated $500 per member. For a plan with 75,000 members, that translates to approximately $37.5 million in additional funding.
In 2025, only 40% of Medicare Advantage plans reached four stars or higher, down from 42% in 2024, meaning just 62% of Medicare Advantage members were enrolled in high quality plans, compared to 74% the prior year. With CMS simultaneously raising performance cut points and proposing significant structural changes to how Stars are calculated going forward, the pressure on plans to improve year over year has intensified.
Where Member Education Intersects with Quality Measures
The connection between patient education and HEDIS performance is direct, not theoretical. A significant share of HEDIS measures evaluate whether members are completing specific clinical activities such as preventive screenings, chronic disease management tests, follow up appointments, and medication refills. Many members who are eligible for these activities fail to complete them not because they refuse, but because they do not understand why the activity matters, do not know how to access it, or have not received a trusted, timely nudge to act.
That is precisely the gap that member education content fills.
Consider a few high impact HEDIS measures and the role education plays in closing them:
- Preventive Screening Measures. Colorectal cancer screening, breast cancer screening, and cervical cancer screening rates are among the most closely watched HEDIS measures for commercial and Medicare plans. Members who receive clear, accessible education on why these screenings matter, what to expect, and how to schedule them are more likely to complete them on time. Content that addresses common anxieties, fear of results, concern about procedure discomfort, distrust of the healthcare system, has an additional behavioral function that a claims based reminder cannot replicate.
- Diabetes Care Management. The Comprehensive Diabetes Care cluster of HEDIS measures tracks HbA1c testing, eye exams, nephropathy screening, and blood pressure control among members with diabetes. Consistent engagement with diabetes self management education content, explaining what HbA1c means, why retinal exams are essential, and how to manage blood sugar through diet and medication, directly supports the clinical activities these measures track.
- Medication Adherence. Three of the most heavily weighted measures in the Medicare Advantage Star Rating system are medication adherence measures for cholesterol (statins), hypertension (RAS antagonists), and diabetes. These triple weighted measures have a force multiplier effect on the overall Star Rating, and performing well on them is critical for plans seeking to maintain or reach the 4 Star threshold. Member education that explains why continuous medication use matters, not just reminders to refill, addresses the underlying behavioral barrier: members who do not understand the clinical rationale for maintenance medications are less likely to remain adherent.
- Behavioral Health Follow Up. Measures tracking follow up after a mental health hospitalization, depression screening, and antidepressant medication management have grown in significance. Educational content that destigmatizes mental health care, explains what follow up appointments involve, and supports members in understanding their treatment options plays a meaningful role in completion rates for these measures.
The CAHPS Connection
Member experience surveys, particularly the CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey, are heavily weighted within Star Ratings. By 2029, CAHPS and HOS measures will make up nearly 40% of total Star Rating weight, meaning the voice of the member will increasingly determine market winners.
CAHPS domains assess members’ ability to get information from their health plan, the helpfulness of communications, ease of accessing care, and overall satisfaction. Plans that invest in quality member education content directly support favorable CAHPS performance, because members who understand their benefits, know how to access care, and receive ongoing support from their plan are the members who report positive experiences.
J.D. Power’s 2026 Healthcare Digital Experience Study noted that once health plan members spend time familiarizing themselves with their health plan’s digital channels, their overall customer experience improves significantly, but that it takes meaningful time to get there, highlighting the opportunity for health plans to invest in digital onboarding and ongoing member education.
Content Strategies That Drive Gap Closure
The most effective content strategies for HEDIS and Stars performance share several characteristics.
Year round engagement, not seasonal outreach. Plans that treat HEDIS as a year end sprint, launching outreach campaigns in Q4 to close gaps before the measurement year closes, consistently underperform compared to plans that educate members on preventive care needs throughout the year. By the time a reminder goes out in November, many eligible members have already missed the window to complete a screening for that measurement year.
Condition specific sequencing. Members managing chronic conditions need education that evolves alongside their health journey. A newly diagnosed diabetic needs different content than a member who has managed Type 2 diabetes for a decade. Effective content libraries enable condition specific, staged educational journeys that support the clinical milestones HEDIS measures are designed to capture.
Multichannel delivery. Even emailing or mailing comprehensive education materials to patients on the benefits of screenings often isn’t sufficient on its own; effective gap closure requires an intelligent, data driven strategy with multiple touchpoints. Content must reach members through the channels they actually use, such as mobile apps, member portals, email sequences, text based communications, with the clinical message consistent across all of them.
Multilingual content as an equity and quality strategy. For plans serving populations that include Spanish, French, Chinese, or other language communities, multilingual education is not optional, it is a prerequisite for equitable access to the clinical activities HEDIS measures track. Plans with significant non-English speaking populations that deliver education only in English will see persistent, systemic gaps in preventive care and chronic disease management measures.
Trusted, clinically reviewed sources. Health plans have an opportunity to leverage health education for older adult populations in particular to boost Star ratings, realize cost savings, and improve member outcomes and experiences. But that opportunity depends on the credibility of the content being delivered. Members who receive inaccurate or confusing health information disengage, or worse, disengage from care entirely. Clinical review and content accuracy are not marketing considerations, they are quality program requirements.
What the Data Says About Content Driven Gap Closure
The evidence base connecting member education to quality measure improvement is growing.
A web based health literacy and education intervention demonstrated that hospitalizations per 1,000 members fell 32% and emergency room visits declined 14% following implementation, with per capita annual costs falling by 10.8%. These outcomes align with the clinical logic behind preventive care measures and when members better understand their health and are supported to act on it, avoidable downstream utilization decreases.
For HEDIS specific gap closure, the results of structured engagement programs are similarly encouraging. One engagement program working with a Medicare Advantage plan partner closed 88,000 care gaps with a 76% overall member activation rate. That scale reflects what is possible when education, outreach, and data driven targeting are coordinated systematically.
Best Practices for Quality Leaders
- Map your content library to your HEDIS measure set. Identify which of your highest weighted measures have the greatest care gap rates, and ensure that clinically accurate, accessible education content exists for each of them.
- Integrate education into care management workflows. Content should reach members not just through general portal access, but through care management touchpoints, nurse outreach calls, case management interactions, post discharge follow up.
- Leverage member data to personalize outreach. Members with gaps in diabetes care management should receive diabetes specific education and members overdue for mammography should receive breast cancer screening content. Generic health content delivered to a care gap population is less effective than content matched to the specific gap.
- Evaluate content partners for clinical credibility. If your organization licenses or partners for member education content, assess clinical review processes, evidence alignment, content update cadence, and multilingual capability. Quality programs cannot be built on content that does not meet clinical standards.
- Track content engagement as a leading indicator for quality measure performance. Plans that build the analytics infrastructure to connect content engagement to downstream HEDIS outcomes can identify which education investments are driving gap closure, and optimize accordingly.
HEDIS and Star Ratings are ultimately measures of whether health plan members are receiving appropriate, effective care. The single most scalable lever for closing gaps between what HEDIS measures require and what members actually complete is education, delivered consistently, accurately, accessibly, and in the right language at the right moment. Plans that treat member education as a compliance activity or a communications function will continue to see gap closure driven by expensive last mile outreach. Those that treat it as a year round clinical engagement strategy will find their HEDIS performance and Star Ratings following accordingly.
CARAVAN Wellness provides health plans, digital health platforms, and employers with a licensed library of clinically reviewed, evidence based health and wellness content, available in multiple formats and languages, designed to integrate directly into member facing experiences. Explore Content Licensing or Schedule A Demo.
