From Measurement to Activation: What the CY 2027 Final Rule Makes Clear About Member Action
Where Performance Breaks Down
Medicare Advantage plans have made meaningful progress in identifying care gaps and improving performance across measures. The data is stronger, analytics are more advanced, and prioritization is well established. The challenge is execution.
Plans know which members are overdue for care, where adherence breaks down, and where documentation is incomplete. Translating that insight into completed actions at scale remains inconsistent though, and that is where performance is determined.
This is what the CY 2027 Final Rule brings into focus. The rule does not introduce significant new complexity. It removes it.
“These changes refocus the program on clinical care, outcomes, and patient experience where meaningful performance differences exist across contracts and reduce administrative burden by removing measures that provide little meaningful distinction between plans.”
— CY 2027 Final Rule Fact Sheet
As measures are streamlined and expectations clarified, performance is more directly tied to outcomes. For plan leaders across Quality, Stars, Risk Adjustment, Experience, and Finance, the implication is straightforward. Results will depend less on identifying opportunities and more on ensuring they are completed.
From Identification to Completion
Most organizations have solved the front end of the problem. They can identify care gaps, segment populations, and initiate outreach with precision. Performance is determined by what happens next.
Whether members schedule needed visits, complete them, have conditions documented, and follow through on next steps drives outcomes. At each stage, there is potential for drop off, and those gaps, not lack of insight, separate a 3.5 Star rating from a 4, or a 4 from a 4.5.
The Final Rule makes this dynamic more visible, as Star Ratings continue to drive revenue and competitiveness, risk adjustment depends on completed and documented visits, and member experience reflects how effectively individuals are supported through care.
Plans can flag that a member is overdue for a screening, but they cannot always explain why it has not been completed. Barriers such as access, confusion, or competing priorities are difficult to capture and even harder to address through traditional approaches.
From Programs to Managed Journeys
Many organizations still manage performance through programs aligned to individual measures. Members, however, experience care as a sequence of actions.
This reflects a broader shift in how Medicare Advantage operates, from a model built around programs and measures to one where performance depends on how effectively plans guide members through that sequence. As measures are streamlined, variation in performance will increasingly come down to execution across those actions, not just whether the opportunity was identified.
A single care gap often represents multiple downstream impacts. For example, a member overdue for an annual wellness visit is engaged and helped to schedule. That visit enables diagnosis capture and documentation, supporting RAF accuracy. Follow-up reinforces next steps such as screenings or medication adherence. What begins as a quality gap becomes a series of connected actions that drive Star performance, risk revenue, and downstream outcomes.
Driving Behavior Change
Managing performance as a set of connected journeys makes the underlying challenge more explicit. It is not enough to reach members. Plans need more consistent ways to move them from awareness to action, reduce friction, and support follow-through across each step.
When members are guided through what to do next, they are more likely to follow through and complete the actions required. Over time, that consistency leads to more sustainable performance.
This is where Drips supports execution. Through two-way conversational outreach, plans can guide members through required actions and reinforce next steps, increasing the likelihood that those actions are completed consistently and at scale.
What Comes Next
The timing of the Final Rule matters because policies tied to CY 2027 begin influencing measurement periods well before performance is reflected in Star Ratings. By the time results begin to shift, the underlying behaviors driving those outcomes are already established.
For plan leaders, the priority is to strengthen execution now by improving visit completion, documentation capture, adherence, and continuity across the member journey. The organizations that outperform will be the ones that consistently ensure opportunities are completed at scale.
