The Health Outcomes Survey (HOS) is one of the hardest Star Ratings domains to improve - and one of the easiest to misunderstand. Plans often approach HOS like a typical Stars “campaign”: run a burst of outreach, refresh member education, and hope scores move within the year. But HOS doesn’t work that way.
Two realities make HOS especially tricky. First, it measures how members function and feel over time, not whether they remember a one-time interaction. Second, HOS performance takes years to show up in Star Ratings - meaning late-cycle pushes rarely pay off. Historically, many plans deprioritized HOS because it carried less weight. That mindset is changing. As CMS increases the emphasis on outcomes, and thus, HOS at a whopping 12% of Star Ratings this year, plans that don’t build a durable HOS strategy risk leaving 4 Star or better performance on the table.
Compounding the challenge: HOS measures are widely misunderstood. Below, we’ll break down some of the most persistent myths and what they mean for your HOS strategy, so your plan can focus effort where it actually moves the needle.
Unlike CAHPS, when your vendor attempts outreach and discovers that the member is institutionalized but still able to complete the survey, the vendor must ask for the member’s contact information. If the institutionalized member cannot complete the survey, the vendor is required to attempt to identify an appropriate proxy to complete the survey on behalf of that member. Only if no proxy is available can the vendor classify it as "Nonresponse: respondent institutionalized."
Significance: Institutionalized members can be a critical component of your HOS strategy. Any HOS strategy your plan takes should be a population-wide effort, ensuring a stratified focus on different cohorts of members, especially your most vulnerable members.
If the denominator is less than 100 for any of the five (5) Star Ratings HOS measures, the result is suppressed and not reported.
Significance: This means that even if a plan invests heavily in improving all five HOS measures, it will not receive a Star Rating score unless at least 100 eligible respondents are in the denominator, limiting the ability to demonstrate performance. As a result, smaller contracts or contracts with low survey response may see suppressed results, making HOS performance highly sensitive to sample size and response rates rather than effort alone.
For this reason, members of small MA contracts often receive the HOS annually and also serve as “double-duty” respondents. “Double-duty” respondents are members who are eligible for the Follow-Up survey and are also randomly selected for the Baseline survey. Double-duty respondents receive only one survey during survey administration because the HOS Baseline and Follow-Up surveys use the same questionnaire.
Significance: This means that in smaller MA contracts, members may effectively influence HOS results more frequently than every two years, increasing the impact of each individual’s perception on overall performance. It also means plans must sustain continuous engagement and experience improvement, because the same members may drive both baseline and follow-up outcomes.
Declining health is expected for many chronic conditions and CMS accounts for this in their model by comparing expected change to actual change. For example, if a member has a chronic condition and experiences a health decline over the two year measurement period, but that decline is the norm for their condition, the member will be classified as “maintaining” health.
Significance: This means plans are not automatically penalized for normal disease progression, as CMS adjusts expectations based on the member’s clinical profile and anticipated health trajectory. The real performance signal is whether the plan helps members maintain or slow decline relative to what is expected, reinforcing the importance of proactive chronic condition management rather than trying to prevent all decline.
CMS counts the member's recollection of the conversation - not who delivered it.
Significance: MA plans sometimes say that doctors are too busy to incorporate a thorough fall prevention conversation with every patient. Good thing any healthcare provider can have this conversation. Even a vendor like Nymbl can be defined as a healthcare provider - and they can have that conversation on your behalf.
Cracking HOS isn’t about finding a clever script or a last-minute outreach tactic. It’s about building a system that improves (or maintains) member function day to day - especially for your most vulnerable members - and makes that system evergreen so that the impact shows up down the road.
That’s exactly where Nymbl fits.
Nymbl delivers year-round, scalable engagement that supports the HOS outcomes which episodic outreach alone cannot reach. Nymbl accomplishes this by helping members improve balance and mobility before a fall happens, rebuild confidence after close calls, and stay active and independent over time through balance training and HOS-oriented education.
Because Nymbl is consistent, measurable, and designed for broad populations (not just the “easy wins”), it aligns with how HOS is actually scored: progress (or slowed decline) over a multi-year window.
If your plan is serious about improving outcomes, HOS will become a differentiator. Nymbl helps you make that shift with a population-wide approach that supports member function, protects medical spend, and positions you for Stars success in the years ahead.
SVP of Sales
jeff.voss@nymblscience.com