In this section, you’ll find:
• CAHPS survey background and measures
• HOS Outcomes Survey background and measures
• The Cigna Healthcare Augment and Post-visit survey background
• HEDIS background and measures
• Pharmacy measures
• Other Star domains
Consumer Assessment of Healthcare Providers and Systems
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey offers a glimpse into patients’ perceptions about key aspects of their care. The good news is that the CAHPS survey is weighted heavily in Star ratings and focuses on measures that you and your staff can positively affect, including
CMS uses the CAHPS survey to measure patient perception of their health care experience. CAHPS will comprise approximately 25% of the 2026 Star rating and collects data from 21 of the survey questions to calculate the Star ratings for the following measures:
1. HEDIS measure information can be found here.
2. Part D measures can be found here.
A patient’s experience with providers can greatly affect their response to CAHPS survey questions. Click here for a list of CAHPS questions that you can affect.
The Health Outcomes Survey (HOS), conducted by a CMS-approved vendor, is an anonymous annual survey related to patient-provider relationships and asks questions about physical and mental health, incontinence, physical activity, fall risk and prevention, and other topics. A second follow-up survey is sent two years later to the same subset of patients as the initial survey to measure trends in their health outcomes over time.
CMS uses the HOS survey to measure patient perception of their physical and mental health. HOS will comprise 7% of the 2026 Star rating and collects data from 15 of the survey questions to calculate the Star ratings for the following measures:
We conduct our own mock survey, the Augment survey, to collect data on topics surveyed through CAHPS and HOS. Results from the Augment survey are used to develop strategies for both Cigna Healthcare and providers to improve patient health outcomes and overall experience. The Augment survey is sent in July and reporting with patient and provider-level information is available in November of each year. We also send supplemental surveys throughout the year to help gauge customer experience relative to CAHPS and HOS metrics, one being the post-visit survey. Post-visit surveys are triggered by claims from your practice for routine or sick care visits by patients with Cigna Healthcare Medicare Advantage coverage and are sent via mail or email. The Augment and post-visit surveys can be reliable indicators of your practice’s potential score on the CAHPS survey that follows, which can serve as a valuable preview of what your patients are saying about their care experience with your practice. CAHPS survey responses can ultimately impact your practice; therefore, it’s important to encourage your patients to complete any surveys they may receive. Survey results, reporting, and other educational materials will be provided to you through your Provider Performance Enablement representative.
HEDIS is a group of performance metrics that rate provider compliance related to preventive screenings and clinical activities. Based on claims, medical records, and laboratory data, HEDIS results are calculated by health plans and reported to the National Committee for Quality Assurance (NCQA).
The HEDIS portion of the Star rating covers clinical quality outcomes for customers enrolled in Medicare Advantage Plans, and is comprised of 14 measures that make up 30 percent of the overall 2026 Star rating.
In addition to the best practices for improving overall Star ratings, there are actions that you can take to improve rates for HEDIS Star metrics. Use the list and table below to learn more about general best practices and how they apply to each metric:
Regular patient engagement. This includes utilizing office visits for:
− 360 Comprehensive Assessment,
− appropriate screenings, and
− maximizing opportunities for appropriate coding.
Provide Cigna Healthcare with quality data through:
− Claims and encounters,
− appropriate documentation and coding, including Frailty and Advanced Illness,
− CPT II codes and
− Electronic health record (EHR) access or other HEDIS-approved templates to provide supplemental data.
Utilize Cigna Medicare Advantage Stars reporting to keep track of open gaps.
Consider utilizing telehealth and vendor options to close gaps.
Connect to local HIE.
Help prevent hospital readmissions to help PCR, FMC, and TRC rates.
Promote Cigna Healthcare customer resources.
Support record retrieval for hybrid measures throughout the year, but specifically during MRR for applicable measures
CMS adopts measures from the Pharmacy Quality Alliance (PQA) to ensure that your patients are prescribed and taking appropriate medications to manage their conditions. Star ratings are calculated from data collected on the following measures:
For ways to improve pharmacy measure rates, see the “Pharmacy measures can be a Star maker” section.
Cigna Healthcare provides reporting for Star measures, including Pharmacy measures. Learn more about Stars Reporting.
For other pharmacy-related resources, including Cigna Healthcare Medicare Advantage Drug List Formularies, visit MedicareProviders.Cigna.com > Pharmacy Resources.
Health plan operations measures, or administrative measures, and quality improvement measures make up almost a third of the overall Star rating. Both domains can be driven by measures from other domains. For example, overall patient satisfaction (measured by CAHPS) could result in disenrollment or complaints made to 1.800.MEDICARE (633.4227), which are both measured by administrative measures. Also, if certain HEDIS metrics show significant decline or improvement, quality improvements ratings will be affected accordingly.
Click here for a full list of administrative measures, and here for information on quality improvement measures.