Subbu Ramalingam, Managing Director, ATTAC Consulting Group
As we enter the second half of 2025, health plans and provider organizations are approaching a critical strategic inflection point. With the final push to close out 2026 health plan products, HEDIS® seasons and CAHPS® surveys—and the ongoing need for momentum in gap closure and revenue optimization through prospective and retrospective reviews— the stakes are high.
In value-based programs like Star Ratings, risk adjustment, quality, and total cost of care, there are three parallel tracks:
- Rear-view analytics and data collection, including evaluating the impact of prior-year initiatives and looking forward to Star Ratings, risk revenue and final incentives payouts to providers
- Real-time execution by delivering on current priorities for members and patients that affect next year’s business results and health outcomes
- Forward investment through building infrastructure, modernizing technology, exploring new benefits and programs to shape outcomes for the next two years
It’s a tall order, especially in the face of shifting federal, CMS and state regulations, combined with a rapidly evolving technology landscape.
Here are five steps to build sustainable Star results and a high-performing organization:
- Validate and Re-Validate—Early and Often
CMS’s final call letter and HPMS guidance are moving toward stricter dispute deadlines and CMS is aggressively looking to RADV audits. It’s time to strengthen your internal validation workflows or bring in external resources. You will also need to create 2026 Star Rating scenarios—not to just track impact and where you’ll land in your ratings, but to inspire immediate action to improve. Keep in mind that validating chronic conditions for over-coding may prevent RADV risks while tying a member’s eligibility to a clinical Star measure.
- Prioritize… and Be Ready to Re-Prioritize
From drug pricing reforms to Medicaid changes, CMS and the new administration are moving quickly. For example, health plans are still working to coordinate providers, pharmacies, and members around the two new Part D measures for the 2025 measurement year. Plans must stay agile, unite cross-functional teams, and focus on what they can control. By reinforcing this mindset organization-wide, plans can better prioritize what is certain—and be ready to pivot when needed.
- Start 2026 Budgeting & Goal setting Now
Digital transformation and interoperability requirements are multi-year initiatives. Do not wait for enterprise budget cycles to voice your needs. Start now by planning quality interventions, digital maturity investments, and ROI models. If you need to re-set goals for the rest of the year and get a head start for 2026, this is the time to bring internal and external experts together to refine goals and metrics.
- Secure Leadership Buy-In with Value Stories
Take digital HEDIS and quality as an example. This is a multi-year, non-linear transformation that impacts not just Star Ratings, but the entire healthcare delivery system. Do not wait for a perfect blueprint. Start with an ROI-driven analysis using small test cases and pilots. Show the potential impact if scaled, and connect the transformation to your organization’s broader goals—not just the ratings. Set expectations early and often. Clearly define what is needed from people, processes, and technology—with finance, IT, and clinical data teams aligned as co-owners.
- Nurture Talent and Connect the Dots
Technology is evolving rapidly, and interoperability mandates are accelerating. But tech alone is not the solution: empowered leaders and teams are. Significant upskilling is still required to drive meaningful transformation. Identify high-potential team members, align them with key initiatives, and provide the support they need to lead. Star Ratings are complex, spanning everything from patient interactions to advanced process improvements that influence care and experience. Leaders must connect the dots—not just to sustain Star performance, but to optimize risk scores, reduce costs, and ease the burden of chronic disease across the system.
Final Thoughts
Success in this next phase is not just about hitting targets, it’s about building resilient systems and teams that can adapt, lead, and elevate member care. Stay focused,
Stay flexible, and stay connected.
Subbu Ramalingam is a former health plan executive and managing director at ATTAC Consulting Group. Tune in to his podcast, Healthcare STARcast,for insights and practical ideas designed for healthcare executives, operators, clinicians, and innovators ready to lead at the next level.
