Speaking at the Milken Institute Future of Health Summit on Nov. 13, Meena Seshamani, MD, PhD, a deputy CMS administrator and director of the Center for Medicare, said the agency will weight call centers less heavily in payers overall ratings in 2026 and beyond.
“We have already put in place that [call centers] will have a smaller weighting on star ratings moving forward,” Dr. Seshamani said. “It takes time for these things to work their way through because of constantly looking at the methodology.”
According to CMS documents, for 2026 star ratings, CMS will decrease the weighting of measures capturing access, including call center availability. The agency will add three new patient care measures to its weighting.
Dr. Seshamani’s comments come after several major insurers sued the agency to dispute their star ratings for 2025. Centene and UnitedHealthcare disputed the inclusion of “secret shopper” phone calls they say hurt their star ratings.
Centene alleged the inclusion of one phone call which the company says did not connect cost it $73 million in bonus payments from CMS.
Dr. Seshamani said there is a “huge opportunity” to more closely tie star ratings to quality improvement.
“I think there is a lot of opportunity to continue to look at how we can improve star ratings so they are addressing quality, and continuing to hold health plans accountable to ensure quality is improving,” she said.
