As we navigate 2026 and look ahead to 2027, quality is being redefined, shifting away from administrative process measures and toward the depth of the human connection between a plan and its members, as well as the resulting outcomes. In this new landscape, health equity and the member experience are no longer just components of a score. They’re the most vital yardsticks for sustainable growth.
However, delivering personalized, empathetic care to an entire population is an immense operational challenge. As CMS shifts its inventory of measures, the safety net of administrative reporting is disappearing. For health plans, this means that success now depends on the ability to bridge the gap between abstract data and a trusting conversation with a pharmacist.
To navigate these shifting mandates, health plans need more than just a larger workforce. They need the right pharmacy technology to remain flexible. Legacy systems built for yesterday’s volume cannot adapt to tomorrow’s focus on high-touch engagement. Future-proofing your Star Ratings requires a scalable pharmacy SaaS infrastructure that allows your clinical strategy to pivot as quickly as the regulations do, ensuring that every member interaction is both clinically impactful and deeply human.
The landscape of CMS quality measures is undergoing a seismic shift, moving away from process-heavy metrics toward a model that demands clinical depth and aggressive outreach. For Medicare Advantage plans, the next two years represent a turning point where legacy strategies will no longer suffice to maintain high Star Ratings.
Recent proposals from CMS signal a pivot toward high-impact clinical outcomes, effectively removing the administrative measures that many plans have historically relied on to bolster their scores. In 2026 and 2027, the focus is narrowing on the member experience and tangible health results.
Key changes at a glance include:
A significant update to draw attention to is the continued expansion of Medication Therapy Management (MTM) requirements. As eligibility thresholds are lowered, plans must find a way to scale their clinical outreach without diluting the quality of the interaction. Furthermore, with the introduction of new measures like Depression Screening and Follow-Up, the role of the remote pharmacist is evolving from a medication reviewer to a holistic clinical partner.
For health plans, the message from CMS is clear: quality is no longer a reporting exercise; it’s a measurable result of human connection. To thrive in 2026 and 2027, plans must leverage new avenues that offer the flexibility to navigate these regulatory changes while maintaining the high-touch engagement today’s members expect.
To succeed under new CMS standards, health plans must transition from a reactive call center mentality to a proactive clinical partnership. A remote pharmacist network, powered by advanced telepharmacy capabilities, provides the elasticity and expertise needed to support performance in the following ways.
In the current value-based care environment, closing care gaps is about the quality of the intervention, not just checking a box as it was in the past. Remote pharmacists utilize pharmacy SaaS platforms to identify members missing evidence-based therapies, such as statins for patients with diabetes (SUPD), in near real-time.
Unlike medical claims, which often suffer from significant lag, these digital-first interventions allow pharmacists to close gaps before they impact year-end HEDIS measures. By providing high-quality consultations, pharmacists make sure that every outreach is a clinical opportunity, not just an administrative reminder.
Medication adherence remains one of the most heavily weighted components of the Star Rating system. Remote pharmacists serve as a persistent clinical layer between the physician and the member, identifying barriers to adherence, such as cost, side effects, or health literacy, long before a refill is missed.
Through regular, data-driven touchpoints, these experts can pivot from simple reminders to complex medication reconciliation, making sure members remain on track with therapy for chronic conditions like hypertension and cholesterol.
With CMS placing a premium on the Health Equity Index, plans are now rewarded for how effectively they serve at-risk populations. This is where the remote pharmacist model shines. By leveraging a geographically and culturally diverse network of clinicians, plans can match members with pharmacists who share their native language, cultural background, or regional nuances.
Ultimately, addressing Social Determinants of Health (SDoH) is fundamentally rooted in trust. A pharmacist who understands a member's specific community can more effectively navigate barriers like pharmacy deserts or transportation issues, directly influencing equity-based quality metrics.
One of the greatest risks to CAHPS scores is member abrasion, which is the frustration caused by fragmented, repetitive outreach from multiple plan departments. A unified pharmacy technology approach allows a single pharmacist to address multiple clinical needs in a single bundled conversation. Instead of receiving three different calls for MTM, adherence, and a gap in care, the member has one comprehensive, meaningful interaction with a remote pharmacist. This one-and-done clinical approach respects the member’s time, fosters deep trust, and significantly boosts overall member satisfaction.
By prioritizing the member experience and addressing the nuances of health equity, health plans cultivate a foundation of loyalty that protects their performance against future regulatory shifts. However, achieving this level of personalization for an entire member population requires a shift in how clinical resources are deployed.
With the upcoming changes to CMS quality measures, the ability to deploy clinical expertise at scale is a competitive necessity. The remote pharmacist model offers a level of agility that traditional, brick-and-mortar or centralized call-center models simply cannot match. By decoupling clinical care from the physical pharmacy and the constraints of a 9-to-5 office setting, health plans can achieve a more resilient and responsive quality strategy.
This decentralized approach transforms how plans interact with their most complex members, moving away from high-volume, low-value outreach toward high-impact clinical interventions. For plans looking to protect their Star Ratings and optimize HEDIS measures, the advantages of integrating remote clinical pharmacy include:
While the advantages of a remote workforce are clear, the challenge for most health plans lies in the execution. It’s time to move away from rigid, legacy systems toward a dynamic infrastructure that can synchronize pharmacist expertise with real-time member needs.
As the pharmacy industry moves toward 2027, the margin for error in clinical pharmacy performance is shrinking. With the sunsetting of administrative process measures and the return of MTM as a heavy-weighted Star Rating driver, health plans can no longer rely on static, legacy systems. Future-proofing your quality strategy requires more than just clinical knowledge; it requires a delivery model that is as agile as the regulatory landscape itself.
At Aspen RxHealth, we’ve developed a solution that helps health plans navigate incoming CMS changes. By removing the need for a clinical pharmacist from the traditional dispensing pharmacy, we provide health plans with the two most critical assets for 2027: unprecedented flexibility and massive scalability.
For plans with established internal teams, our SaaS platform, Alliance by Aspen RxHealth, offers a path forward. Alliance gives organizations the ability to leverage proven technology, standardized workflows, and robust reporting tools while empowering their in-house teams, including pharmacists, pharmacy interns and technicians, and nurses, to deliver care across any device at scale. With its customizable engagement models, real-time analytics, and seamless member interaction tools, Alliance helps health plans drive better outcomes, improve operational efficiency, and maintain CMS compliance.
If your in-house team needs additional help during peak seasons and MTM eligibility surges, Aspen RxHealth’s network of remote pharmacists can be leveraged to help during those times. This means that no member is left behind and that your CMR completion rates remain resilient, regardless of volume.
The 2026 and 2027 measurement years will reward plans that prioritize high-impact human connection supported by world-class technology. By unifying a sophisticated pharmacy tech stack with a deeply human approach, Aspen RxHealth ensures your quality strategy is not just a reporting exercise, but a catalyst for long-term member loyalty and clinical excellence.
To be successful among the upcoming changes to Star Ratings, don’t wait to book your demo with the Aspen RxHealth team.