In this section, you’ll find:
• How we work with providers
• Reporting options
• Changes to Star ratings
We have teams focused on driving five-star quality outcomes for you and your patients. Here are some highlights of the work our teams do for you on a daily basis:
Create synergies, enhancements, and drive insights.
Develop strategies to drive performance at the health plan, provider, and patient level through education and measure-specific initiatives.
Work directly with customers to encourage engagement with their PCP based on clinical triggers.
Stars reporting often uses measure abbreviations that can be found here.
Cigna Healthcare provides reporting with patient-level information around open gaps in care. This information is intended to help you provide the best possible care and achieve the highest possible Star rating. Please use the list below to see the full suite of reporting resources available through your Provider Performance Enablement team:
Additional market-specific reports may also be available through your Provider Performance Enablement representative. Examples of some reports are:
Medication Adherence Tracker (MAT) Target Lists
− Available in all markets. Distribution methods may vary. Contact your Provider Performance Enablement representative for details.
Other useful views available with Provider Enablement Stars Dashboard:
− Summary: Year-to-date rates and Star scores for HEDIS (Part C), PDE (Part D), and Customer Experience (Post-Visit Survey) all in one place.
− Part C and D Goals: Shows a more detailed look at HEDIS (Part C) and PDE (Part D) performance. Year-todate performance can be compared to monthly goals and prior year performance.
− Part C and D YTD Deep Dive: Shows either the rate percentage, Star score, or gap count of all the Part C and D measures.
− Post-Visit Survey: Shows a more detailed look at the Customer Experience/Post-Visit Survey performance by quarter.
− Survey Comments: Comments that customers are leaving while completing the Post-Visit Survey.
CMS updates its Five-Star Quality Rating System annually to include new measures, update existing measures, retire measures, and display measures that may be included in future Star ratings. Here are some examples of recent changes to the Star measures and some potential changes in the near future:.
HEDIS measures
Controlling High Blood Pressure (CBP) is 3x weighted starting with the 2025 Star rating
Plan All-Cause Readmission (PCR) is 3x weighted starting with the 2025 Star rating
Kidney Health Evaluation for Patients with Diabetes (KED) is 1x weighted starting with the 2026 Star rating
Colorectal Cancer Screening (COL) will no longer have the hybrid reporting option starting with the 2026 Star rating
Hemoglobin A1c Control for Patients with Diabetes (HBD) is renamed to Glycemic Status Assessment for Patients with Diabetes (GSD) and includes glucose management indicator as an option to meet numerator criteria starting with the 2026 Star rating
Denominator eligibility criteria are being updated starting with the 2026 Star rating for the following measures: Glycemic Status Assessment for Patients with Diabetes (GSD), Eye Exam for Patients with Diabetes (EED), Kidney Health Evaluation for Patients with Diabetes (KED). The denominator eligibility critera are now:
− Two diagnoses of diabetes during the measurement year or year priorOR
− Dispensed Insulin or hypoglycemics/antihyperglycemics during the measurement year or year prior with one diagnosis of diabetes during the measurement year or year prior
COA Functional Status Assessment (COAFSA) is on display starting with the 2023 Star rating and will return as 1x weighted for the 2027 Star rating (2025 dates of service)
COA Pain Assessment (COAPA) will be retired for the 2027 Star rating
Colorectal Cancer Screening (COL) eligible age range will be expanded from 50-75 to 45-75 starting with the 2027 Star rating
Medication Reconciliation Post-Discharge (MRP) stand-alone measure will be retired for 2027 Star rating but will remain a sub-measure within Transitions of Care (TRC)
The following measures are on display and may be included in future Star ratings:
− Adult Immunization Status
− Depression Screening and Follow-Up for Adolescents and Adults
− Social Need Screening and Intervention
Pharmacy Part D (PDE)
Med Adherence for Diabetes Medication, Hypertension (RAS Antagonists), and Cholesterol (Statins) measures will be updated to implement continuous enrollment instead of the member year calculation for the denominator starting with the 2026 Star rating
The following measures will be added as 1x weighted measures for the 2027 Star rating:
− Concurrent Use of Opioids and Benzodiazepines
− Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults
Medication Therapy Management (MTM) Program Completion Rate for Comprehensive Medication Review (CMR) will move to display starting with the 2027 Star rating and is expected to return as a measure with 1x weight for the 2029 Star rating
Antipsychotic Use in Persons with Dementia
Use of Opioids at High Dosage in Persons Without Cancer
Use of Opioids from Multiple Providers in Persons Without Cancer
Polypharmacy: Use of Multiple Central Nervous System-Active Medications in Older Adults
Initial Opioid Prescribing for Long Duration
HIV Antiretroviral Medication Adherence
CAHPS
The following CAHPS measures will move from 4x to 2x weighted starting with the 2026 Star rating:
Getting Needed Care
Getting Appointments and Care Quickly
Customer Service
Overall Rating of Health Care Quality
Overall Rating of Plan
Care Coordination
Rating of Drug Plan
Getting Needed Prescription Drugs
HOS
HOS measures around Improving and Maintaining Mental and Physical Health, formerly 3x weighted, were removed from the Star rating and placed on display for 2024 and 2025 Star ratings. These measures will return as 1x weighted measures for 2026 Star rating and 3x weighted measures for 2027 Star rating.
Administrative measures
The following Administrative measures will move from 4x weighted to 2x weighted starting with the 2026 Star rating:
Call Center – Foreign Language (FL)/TTY (Part C)
Call Center – FL/TTY (Part D)
Complaints about the Health Plan
Complaints about the Drug Plan
Members Choosing to Leave the Plan (Part C)
Members Choosing to Leave the Plan (Part D)
Appeals Decisions (Part C)
Appeals Timeliness (Part C)