By Paulette Wunsch, October 1, 2026
The Medicare Advantage Plan All-Cause Readmissions measure was display-only for several years before returning to the Star Ratings in 2024 with a weight of one. Its weight then increased to three in the 2025 Star Ratings. This increased weight will continue for the 2027 Star Ratings using the 2025 data for the measurement year. Medicare Advantage plan quality teams have focused closely on how to capitalize on the measure. The increased weight also creates an opportunity for providers and vendors to help plans improve their Star Ratings while improving outcomes for the patients they serve.
Star Ratings is a competitive sport; a higher weight gives plans an opportunity to outperform their competitors. Plans with at least four stars may receive quality bonus payments and rebates that can help fund additional benefits for beneficiaries. A five-star rating also allows a plan to steal away willing beneficiaries outside the usual enrollment periods with the enticement of extra benefits. Prominent stars on Medicare Plan Compare may attract beneficiaries trying to choose among many plans. For a plan near a ratings threshold, better performance on a measure with a weight of three may be especially valuable.
Star Ratings can influence behavior, whether viewed as a carrot or a stick. To be clear, this measure does not penalize emergency department (ED) visits or reward plans for avoiding them. It addresses unplanned acute inpatient admissions, or observation stays within 30 days of discharge, regardless of whether the reason for the return is related to the initial admission. The measure also has exclusions. For example, CMS excludes hospital stays for members with “a principal diagnosis of pregnancy on the discharge claim,” as well as members in hospice care during the measurement year. See CMS’s 2026 Star Ratings Technical Notes, Measure C18: Plan All-Cause Readmissions, p. 53, webpage 62. (The 2027 technical notes that been provided to the plans follow 2026.)
How can providers and vendors help Medicare Advantage plans reduce readmissions within 30 days of discharge?
Medicare Advantage plans can support services that closely follow patients after they return home.
1. Family caregiver programs
Some Medicare Advantage programs give family caregivers access to a care navigator. A family caregiver who spends substantial time with a patient may notice changes in symptoms, appetite, mobility, or the effects of medication between clinical visits.
Caregiver training, a clear escalation plan, and access to a care navigator can help address concerns promptly. Smart AI tools may also help navigators manage their work and respond to caregivers without becoming overwhelmed by the number of people they assist.
A client RubyWell, whose data I am familiar with, is developing this approach. Data from its ongoing pilot in Pittsburgh suggests benefits from supporting family caregivers at home with care navigator guidance and a stipend that recognizes their continuing care for the patient. The pilot data also suggests that regular remote visits with a care navigator reduce unnecessary ED visits and the likelihood of an unplanned readmission.
The goal of these services is to prevent complications and arrange prompt treatment after discharge, not to discourage a caregiver from taking a patient to the ED when needed. An ED visit without a subsequent inpatient admission or observation stay does not count against a plan under this readmissions measure.
There is also a measure to determine if there has been a timely follow-up after an ED visit and the family caregiver can be trained that if the patient has an ED visit that there must be a follow-up with the health care provider within seven days. The Follow-up After ED visit for People with Multiple High-Risk Chronic Conditions C21 is a measure that plans with a family caregiver program should not miss.
2. Home health agencies
Arranging home health services as part of discharge planning, when appropriate, can also help prevent an unplanned readmission. Timely skilled nursing or therapy visits allow a home health team to assess symptoms, review medications, and communicate concerns to the ordering clinician.
Medicare’s home health agency coverage has eligibility requirements, including a need for intermittent skilled services and homebound status. The Medicare home health agency benefit does not typically provide the continuous care that the family caregiver can provide. See Medicare’s home health coverage information.
3. Transitional care management and remote patient monitoring
Under Original Medicare, CMS pays eligible clinicians for transitional care management (TCM). Some Medicare Advantage plans also cover TCM. It covers care management during the 30 days after a qualifying discharge to the community. TCM requires contact with the patient or caregiver within two business days, medical decision-making, and a face-to-face visit within 14 days for moderate-complexity cases (CPT 99495) or seven days for high-complexity cases (CPT 99496).
Reviewing discharge instructions, reconciling medications, arranging follow-up services, and addressing new symptoms can help identify problems before they lead to a preventable readmission. See CMS, Transitional Care Management Services.
Medicare also pays for medically necessary remote patient monitoring (RPM) of certain acute or chronic conditions. Connected devices can transmit blood pressure, weight, oxygen saturation, or other physiologic data to the treating team. A concerning change can prompt a call, medication adjustment, office assessment, or appropriate urgent care before the patient’s condition deteriorates. RPM payment can cover qualifying device setup, device supply and data transmission, and clinical treatment management when the applicable requirements are met. See CMS, Remote Patient Monitoring.
The strongest opportunity is to connect these services: a family caregiver who knows when to call a care navigator, a home health team that can assess the patient, and a clinician who can act on follow-up findings or monitoring data. The measure begins with the index admission and is calculated upon discharge to include all qualifying readmissions, not only those considered avoidable. Even so, reducing avoidable readmissions can improve a plan’s overall performance on the measure.