Assessment of Medicare Advantage Stars Measures: Impact on Kidney Care Quality and Future Opportunities.

Abstract

The Centers for Medicare & Medicaid Services (CMS) uses the Star quality program to evaluate Medicare Advantage (MA; Part C) care quality. Since the 21st Century Cures Act, End-stage renal disease (ESRD) enrollment within Medicare has shifted from less than 30% in 2021 with Medicare Advantage to more than 50% in 2024. Given this influx and growing chronic kidney disease (CKD) prevalence, evaluating how Stars measures shape kidney care has significant population health implications. The American Society of Nephrology (ASN) Quality Committee convened a working group to assess the 2026 Medicare Part C & D Stars quality measures. Measures were reviewed using a modified American College of Physicians Measure Review Criteria, which evaluates measure importance, appropriateness, evidence base, specifications, and feasibility, and Stars measures evaluating non-clinical outcomes were excluded (e.g., customer service). The ASN committee evaluated 25 (of 45) Star quality measures that were directly related to clinical outcomes. The committee assessment identified 13 high-validity Star measures that monitored care related to diabetes, hypertension, and care transitions, as well as 12 medium-validity measures that evaluated preventive care and other chronic care areas. The appropriateness and clinical evidence base of Star measures were generally strong but weaker in patients with ESRD. The committee noted concerns with 10 Stars measures that may exclude patients with ESRD. Only one measure captured guideline-directed kidney care (albuminuria screening in patients with diabetes). No Stars measures captured other guideline-directed recommendations, such as CKD screening and risk stratification, nephrology referral, use of kidney pharmacotherapies, CKD education, or pre-emptive kidney transplantation referral. The Medicare 2026 Part C & D Stars measures represent a missed opportunity to align care measures and guideline-directed kidney care to improve outcomes, reduce costs, and advance high-value care for the millions of Americans living with kidney disease.