Focusing Quality Measures on Outcomes and Patient Experience

The Medicare Part D Star Ratings program continues to evolve and align with the measures included in the Universal Foundation, which is a set of high-priority quality measures streamlined across Centers for Medicare & Medicaid (CMS) programs.

CMS recently announced its intent to simplify and refocus the Part C and Part D Star Ratings measure set on “clinical care, outcomes, and patient experience of care measures” where performance is not topped out and where there is more variation in performance across contracts. This was detailed in the Contract Year 2027 MA and Part D final rule, published April 2, 2026.

CMS’s first step was to reduce the number of measures in the program to increase focus on the remaining measures that are important and meaningful. Eleven measures in the Part C and D programs will be removed, taking full effect with the 2029 Star Ratings Year, which is measurement year 2027.

CMS will continue “to see where we can add additional outcome measures in the future.”

The announcement invites important questions. What can and should we measure when it comes to patient care, experience, and outcomes? What matters most to patients and those who care for them?

The CMS Star Ratings Technical Expert Panel in October 2024 provided some suggestions that are noted in the rule, such as “adding more evidence-based, clinical outcomes measures, or redesigning current measures to assess patient outcomes (such as medication adherence).”

There is an opportunity to explore and advance how we evolve measures to more fully capture the patient experience.

PQA, the Pharmacy Quality Alliance, which developed and stewards 5 measures in the 2026 Part D Star Ratings program, is evaluating opportunities to develop new outcomes measures. One area of focus is outcomes of medication therapy management sessions.

PQA also is facilitating conversations to identify and elevate what patients, caregivers, and patient advocates might value and prioritize for future measurement.

The PQA Patient Advisory Council, which was convened in March 2026, provided insights on priorities for quality that can be grouped into four areas:

• Patient counseling and education to help patients understand their medications, their purpose, and the importance of when and how to take them.
• Patient quality of life, as indicated by physical, psychological, and social well-being.
• Safety and adverse effect management to mitigate drug interactions and adverse events. As one council member noted, how can we incentivize and reward pharmacists and other clinicians who catch errors or identify and address dangerous situations?
• Medication cost and accessibility to evaluate the impact of deductibles, copays, and out-of-pocket expenses on patients’ ability to obtain and be adherent or persistent with their medication therapies.

Some existing measures address these issues to a degree, but their importance for patients invites further exploration.

At the 2026 PQA Annual Meeting on May 14, 2026, the closing general session on “Patient Perspectives on Refocusing the Medicare Star Ratings” reinforced these themes.

Panelist Mark Newsom, president of Health Evaluations and a veteran of public and private sector healthcare organizations, encouraged the pursuit of patient-centered measures. We should not be content, he said, to measure what is easy and accessible. We should embrace the challenge of trying to measure what matters.

Newsom said our health care system needs to bring patients into the measure development process earlier and more fully.

That call was echoed by panelist Wenora Johnson, a 3-time cancer survivor and patient advocate. Relaying an anecdote from another patient advocate, Johnson said we should not simply invite patients to the table. We should invite them to the store to help select the ingredients that will determine what’s served at the table.

In other words, don’t create measures that are “patient-centered” and ask patients to validate them at the end of the process. Make patients co-creators in measurement, helping to set priorities and shape measure concepts for development.

This will increase the chances we’re measuring what matters.

For its part, PQA includes three individuals, who represent patients, caregivers, and patient advocates, on its measurement panels. This includes Measure Concept Advisory Groups, Technical Expert Panels, and standing panels that evaluate draft measure concepts or consider updates to existing measures.

PQA engages patients, caregivers, and patient advocates throughout the measure life cycle because their perspectives, insights, and feedback are essential for meaningful, person-centered quality measures.

This approach to engagement and the goals outlined in the recent CMS final rule are aligned with the CMS National Quality Strategy and the person-centered care principles that are part of CMS’ Meaningful Measures 2.0.

Collectively, this supports the broad effort to shift our care system and how we evaluate its quality to be more patient-centered.