Stop Chasing Stars at the Finish Line: How to make Quality a Year-Round Committment

As healthcare becomes more continuous, connected, and personalized, Medicare and Medicaid plans need to rethink their approach to quality improvement. For too long, quality has been treated like a year-end checklist—teams scrambling in Q4 to close gaps, hit metrics, and rush members into last-minute appointments. That pattern is increasingly out of step with how care works today, and what members actually need.

Quality Isn’t a Deadline — It’s a Daily Discipline

Too often, plans go quiet for most of the year, then suddenly spring into action as the calendar winds down. Gap lists get dusted off. Outreach campaigns surge. Everyone races to check boxes before time runs out.

But this scramble isn’t sustainable. It contradicts CMS guidance, which calls for sustained, year-round quality work, not a sprint to the finish. It leads to burnout, missed opportunities, and (most importantly) ineffective care.

Star Ratings don’t measure a moment; they reflect a member’s entire year. Trying to patch up performance in the last few weeks doesn’t work.

Take medication adherence, a triple-weighted Star measure. If a member has been missing doses all year and enters Q4 with under 50% adherence (not uncommon among chronic patients), there’s no way to recover. No number of calls, nudges, or incentives can fix 10 months of inconsistency. Some metrics simply can’t be gamed. They require trust and behavior built over time.

The System’s Evolved and Your Strategy Should Too

Care is no longer confined to clinics. Remote monitoring, virtual visits, and mobile tools have changed how people engage. Members now expect care and communication that’s always on.

Plans that stick to old rhythms risk falling behind. Not just in Star Ratings, but in satisfaction, retention, and outcomes. Quality strategy must evolve to match modern healthcare delivery.

What Year-Round Quality Looks Like

This isn’t about more dashboards or bureaucracy. It’s about smarter engagement. Using behavioral science, data, and technology to deliver the right nudge, at the right time, in the right way.

That might be a well-timed message. A simple reward. A reminder that builds a habit. Do it right, and quality becomes the outcome of consistent connection, not a last-minute scramble.

It’s also cheaper. Keeping a steady pulse on high-risk members lets plans intervene early and avoid costly, reactive care. It’s a win for members and for the bottom line.

This Is the Perx Health Mission

At Perx Health, we help plans move from transactional to continuous. Our programs use behavioral science to reward the small daily actions that build better health outcomes, like taking medications, attending appointments, or checking in with their care team.

The result? We activate over 50% of the member base. Members complete an average of four next-best actions every day. They achieve over 96% PDC adherence. And they stay engaged on the platform for more than six months, consistently.

That level of daily engagement becomes a force multiplier. It lowers the cost and friction of driving one-off actions like completing a health risk assessment or booking a screening. Instead of launching expensive outreach campaigns or building trust from scratch, plans can piggyback on the strong, reliable relationships members already have with Perx. Year-round quality becomes not only achievable but scalable and cost-effective.

A Call to Action

The old way? It’s failing. Plans that rely on end-of-year pushes are putting their Star Ratings, revenue, and member relationships at risk.

CMS is tightening the screws. In 2024, they implemented tougher scoring rules, like the Tukey outlier deletion method, making it harder to boost scores with a few strong measures. At the same time, more beneficiaries are choosing plans based on Stars—over 70% now enroll in 4-star or higher plans.

Fall behind, and you’ll stay behind.

Recent changes—like new measures for Transitions of Care, Follow-Up After ED Visit, and the triple-weighted Controlling Blood Pressure—reward plans that stay engaged year-round. These aren’t boxes you check in December. They require steady work all year.

The message is clear: If you want better results, start now and don’t stop.

Let’s stop chasing stars at the finish line. Let’s build constellations, day by day.

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