5 Things Health Plans Need to Know After Qualipalooza 2026

This year’s Qualipalooza conference brought quality leaders together to make sense of a lot of change at once. The agenda covered it all – STARS, HEDIS®, member experience, Medicaid quality and more.

5 key takeaways stood out to our team about health plan leaders need to know right now – and how to action.

1. STAR Ratings Aren’t Going Away: Medicare Advantage plans are facing lower contract rates, tighter risk-adjustment scrutiny, and mounting litigation pressure. The Clover Health lawsuit is still sending ripples through the industry, but any change is still far into the future. Margins are tighter than ever and plans are struggling.

Despite all of it, the Star Ratings program isn't going anywhere. It may look different in the years ahead, but CMS remains focused on clinical outcomes and member experience, and quality teams are the ones best positioned to deliver both.

2. Focus Stays on What Moves the Needle: Speakers pointed to a few areas that still matter most:

• Medication adherence. Diabetes, RAS antagonist, and statin adherence remain foundational to Star performance.
• Controlling diabetes and high blood pressure. These clinical measures are closely tied to adherence and shouldn't be managed in isolation.
• Member and employee experience. Every touchpoint, whether from a plan employee or a vendor partner, shapes how members experience their care.

3. Think Whole Member, Not Single Measure: A recurring theme was the value of whole-member initiatives. If your team is calling a member about medication adherence, that same member may also fall into the Controlling Diabetes or Controlling Blood Pressure measure. One outreach can address several gaps at once with the right data and the right team.

4. Data and People Both Matter: Getting this right takes both technology and people. Data and analytics should direct your teams to the members who need live outreach most. From there, a skilled care team turns that data into action.

As one speaker put it, "Quality improvement is data-driven and human-dependent." Neither piece works well without the other.

5. Partners Can Help You Move Faster: For plans and vendors trying to apply these lessons, a few next steps stood out:

• Stay informed on regulatory and market shifts, but don't let the noise pull focus from the care members need today.
• If budgets are tight, consider a vendor partner. It may sound counterintuitive, but vendors tend to be nimbler. They are often faster and more cost-effective than building new capabilities internally.

Lastly, don’t wait to invest in the data infrastructure that helps your team prioritize outreach by member need, not just by measure.

The plans that come out ahead won't be the ones reacting to headlines or changing strategy every month. They'll be the ones staying grounded in what truly improves outcomes: adherence, chronic condition management, and a genuinely better member experience.

ActualMeds helps health plans put this exact approach into practice, pairing data-driven targeting with pharmacist-led outreach for the members who need it most.

If your team is navigating these same pressures, we'd welcome the conversation. Schedule a strategy session with our team today to discuss these challenges and more.