Member Services Experience Across Medicare and ACA: Ratings are Revenue
How member services performance now decides your Star Rating, your Quality Rating, and the revenue tied to both.
Thursday,
August 27, 2026
10:00 a.m. PT (1:00, p.m., ET)
30 minutes, plus 15 minutes of live Q & A
Under the 2026 CMS methodology, member experience is a growing share of the Medicare Star Ratings because high-performing administrative measures are being removed, which makes the call center a direct driver of Quality Bonus Payment revenue. The ACA Quality Rating System measures the same contact-center performance through a CAHPS-based survey shown to shoppers. This webinar maps the connection.
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Why Member Experience Is Becoming the Score
For years, member experience was one of many inputs. Now it is the score.
CMS is removing administrative measures that plans previously used to score well on. As those drop away, the remaining experience measures carry more weight in your Medicare Star Rating. The ACA side mirrors this: the Quality Rating System shows shoppers a member-experience score during open enrollment.
Timing is what makes your call center decisive. CAHPS surveys reach members in March, so your first-quarter performance shows up in next year’s survey and in next year’s Quality Bonus Payment.
The dollars are real:
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Roughly $1.3 billion in bonus payments is at risk due to the measure removals
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First-quarter performance sets next year’s survey scores and bonus dollars.
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By 2029, CAHPS and HOS are projected to account for nearly 40 percent of the total Star weight
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A half-star improvement, from 3.5 to 4.0, is worth roughly $20 million for a plan of about 40,000 members — without adding a single enrollee.
What You Will Learn
The connection from a single resolved call to next year’s revenue, made concrete.
The new Star Ratings math
Why a lower per-measure weight, combined with the removal of administrative measures, makes experience a larger share of the rating, not a smaller one.
The revenue chain
How a resolved call traces through CAHPS, complaints, and disenrollment to Quality Bonus Payment and rebate dollars.
The ACA parallel
How the Quality Rating System scores experience, as measured by the CAHPS-based QHP Enrollee Survey, shown to shoppers at the moment of choice.
The measures you actually move
Which survey measures the contact center controls, from Customer Service to the overall plan rating, and the levers behind each?
The team that moves the measures
How the five-role member services team from Session 1 — Warm Welcome, Inbound, Proactive Retention, Onboarding, After-Hours — maps to the specific CAHPS and QRS measures each role lifts.
What to hold the operation accountable for
The leading indicators to manage weekly — first-call resolution, speed and abandonment, transfer rate, complaint volume — and the worked example: a ten-point FCR lift moves four survey measures at once.
Agenda and Who Should Attend
What changed in the methodology?
The weight shift, the measure removals, and why they point in the same direction.
What half a star is worth.
The revenue chain from a resolved call to Quality Bonus Payment and rebate dollars — upside and downside.
The first-quarter survey window.
Why January-to-March performance sets the rating that drives the following year’s revenue.
The team that moves the measures.
One member journey retold as survey answers, and the five roles mapped to the measures each one lifts.
Managing what feeds the survey
Shared metrics, transparent measurement, and a governance cadence that catches drift early — and why the three ways to staff the season are not equal.
Live Q & A.
Bring your member-experience and ratings questions.
Who should attend:
VPs of Member Services, VPs of Stars and Directors of Quality Improvement, VPs of Customer Experience, and chief operating officers at Medicare Advantage and ACA plans who are accountable for ratings and member-experience performance.
What you will walk away with:
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A plain-language model of how member experience now drives the rating and revenue.
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A map of the specific CAHPS and ACA Quality Rating measures the call center uses.
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A set of leading indicators to manage the operation against weekly — in-house or outsourced — well before survey season begins.
Frequently Asked Questions
Did CMS make member experience worth less in 2026?
No. The per-measure weight for experience and complaint measures dropped from 4 to 2, but the removal of high-performing administrative measures means experience accounts for a larger share of the overall rating, projected to be near 40 percent for CAHPS and HOS by 2029.
How does the call center affect Star Ratings?
Member experience measures such as Customer Service, Rating of Health Plan, and access, along with complaints and disenrollment, all trace back to call quality and consistency. These measures feed into the rating that determines Quality Bonus Payment and rebate dollars.
Do ACA plans have a comparable rating?
Yes. The ACA Quality Rating System is a five-star program that is partly based on a CAHPS-derived enrollee survey. It is displayed to shoppers during open enrollment, so experience serves as both a quality and a competitive signal.
Do I need to have attended Session 1?
No. Session 2 stands on its own, and we open with a two-minute recap of the five-role team model. The Session 1 replay is available on-demand if you want the full staffing discussion first.