The CMS Final Rule for contract year 2027 continues to accelerate the “Star Ratings treadmill,” demanding that health plans move beyond simple identification of care gaps toward verifiable clinical activation and longitudinal engagement. At Signify Health, our perspective is clear: The home is the most effective setting to address these evolving requirements, particularly as CMS emphasizes behavioral health access, clinical outcomes and more rigorous Healthcare Effectiveness Data and Information Set (HEDIS®) benchmarks.
Here is how our integrated strategy addresses the key pillars of the 2027 Final Rule:
1. Mastering the new Star Ratings measure for depression (DSF)
With Depression Screening and Follow-Up (DSF) becoming a Star Ratings measure in measurement year 2027, health plans must identify high-risk members and ensure clinical follow-up within a critical 30-day window. Signify Health provides a turnkey solution to this challenge by leveraging the in-home visit as the primary engine for identification and activation:
- Universal screening: Standardized depression screenings (PHQ-2) are completed for 100% of Signify Health evaluations.
- Immediate high-risk identification: Members with behavioral health needs are identified in real-time during the evaluation when clinicians document a PHQ-9 score ≥ 10 or issue a behavioral health referral.
- Rapid clinical follow-up: Identified eligible members are routed to our care coordination service, achieving a 70%+ reach rate within 14 days of evaluation.
- Bypassing access bottlenecks: Our pathway ensures timely intervention that bypasses traditional barriers, such as the median wait time of 67 days for an in-person behavioral health appointment.
- Personalized care navigation: using a "one call to close them all" strategy, coordinators assist members in finding in-network providers or navigating appropriate plan benefits while preserving member choice.
2. Driving HEDIS and Star Ratings performance at scale
The Final Rule requires more precise interventions to maintain high Star Ratings. Signify Health’s integrated approach — combining modular Quality Focused Visits (QFVs) and Care Coordination Pathways (CCPs) — is now strategically positioned to impact 57% of all HEDIS measures.
- Modular gap closure: Our QFVs allow plans to target specific, high-weighted measures such as Kidney Health Evaluation (KED), Blood Pressure Control (CBP) and Colorectal Cancer Screening (COL).
- Proven impact: In recent national pilots, this modular approach addressed critical needs, including closing 76% of HbA1c gaps and 74% of Controlling Blood Pressure gaps.
3. Elevating pharmacy quality and Part D strategy
With Part D measures carrying significant weight, plans need a robust way to manage medication adherence and safety.
- Pharmacy-specific pathways: Our CCPs include dedicated tracks for medication adherence refills, mail-order transitions and the concurrent use of opioids and benzodiazepines (COB).
- Clinical expertise: We utilize licensed clinicians (physicians. physician assistants and nurse practitioners) to conduct comprehensive medication reviews and reconciliation, ensuring that quality ICD-10 coding and pharmacy measures are addressed simultaneously.
4. Reducing member abrasion through integrated engagement
CMS continues to prioritize the member experience through Consumer Assessment of Healthcare Providers and Systems (CAHPS®) and Medicare Health Outcomes Survey (HOS) results, penalizing fragmented outreach that leads to member abrasion.
- Streamlined outreach: Our CCP strategy consolidates follow-up communication into a single, high-value interaction that achieves a 70% reach rate post-visit.
- Primary care connectivity: We tackle the disengagement crisis by identifying members without a primary care provider (PCP) and facilitating direct, three-way warm transfers to schedule visits, ensuring a closed-loop care cycle.
5. Verifiable data and documentation integrity
As auditing becomes more rigorous, documented closure is as critical as the clinical action itself.
- Seamless interoperability: We ensure that every diagnostic result and clinical intervention flows directly to the health plan via HEDIS Supplemental Files.
- New clinical standards: New documentation standards include specific capture for immunizations (RSV, COVID-19 and Hepatitis B) and MAHC-10 Falls Risk assessments to meet Star Ratings and HOS requirements.
The bottom line: For contract year 2027, the plans that succeed will be those that transform the home into a high-impact clinical setting. Signify Health is ready to help you navigate this transition, repositioning your strategy from documentation-only visits to holistic quality performance.