Most Medicare Advantage plans still think about advance care planning as a clinical program. It sits with palliative care. Or care management. Or another team brought in after a member becomes seriously ill.

That’s understandable, but it’s increasingly the wrong way to think about it.

Advance care planning isn’t just a clinical intervention. It’s one of the most meaningful member experiences a health plan can deliver.

And in a world where member experience now directly influences financial performance, it belongs much closer to the center of the plan strategy.

Why This Matters Now

This distinction matters more than ever.

Beginning with the 2027 Star Ratings, CMS is placing significantly greater emphasis on member-reported outcomes through the Health Outcomes Survey (HOS), and survey-based measures are expected to account for nearly 40% of total Stars weight by 2029. In other words, how members experience their health plan is becoming just as important as how efficiently it manages care.

At the same time, total Quality Bonus Payment spending is projected to exceed $12.7 billion in 2025. Small shifts in Stars performance translate directly into meaningful changes in plan economics.

This is no longer a downstream quality initiative. It is core to financial performance.

And it raises an uncomfortable but important truth:

The members who shape your Star Ratings aren’t necessarily the healthiest. They’re the members whose experience with your plan was most memorable.

For many Medicare Advantage organizations, that means members living with serious illness.

These are the members who remember who showed up when decisions became difficult. Who helped them navigate uncertainty. Who asked what mattered to them—not just what was the matter with them.

That is member experience in its most consequential form.

The Problem MA Plans Are Already Living With

The challenges are not new, but they are compounding.

Member churn remains high, with roughly 23% of MA members switching plans annually and nearly half of new enrollees leaving within five years. Even a single percentage point of retention in a 100,000-member book can represent $2–3M in annual revenue impact.

At the same time, satisfaction is under pressure. Recent MA satisfaction scores declined meaningfully, and only a minority of first-year members report that their expectations are being met.

Plans have limited levers to improve this. Many of the tools used to manage cost like prior authorizations, utilization management, and tighter care navigation can improve efficiency while simultaneously degrading experience. Care management capacity is shrinking even as expectations for support continue to rise.

And through all of this, serious illness spend remains highly concentrated, often unmanaged until hospice election, and frequently disconnected from what members actually want.

The measures CMS has removed from Stars were largely operational. The measures it is elevating are experiential. They require something harder: reshaping what members actually feel and remember over time.

And that experience is delivered, increasingly, through vendors.

What Actually Moves Member Experience

Most touchpoints are transactional. They aim to reduce cost, improve adherence, or manage utilization. Important goals, but not the kind that shape how a member feels about their health plan.

HOS doesn’t ask members to evaluate programs. It asks whether their health improved, whether they can do the things they want to do, and whether they feel supported when they need help.

Those responses are shaped by memory more than metrics.

And what members remember is not every interaction. It is a small number of moments:

The person who called when things got hard.
The conversation that clarified uncertainty.
The experience that made them feel seen.

Advance care planning—done well—is one of those moments.

It happens when a member is asked what matters most to them. When they identify someone they trust to speak for them. When they are supported in making sense of what their care should look like if their health declines.

That is not administrative. It is personal. And it fundamentally changes the relationship between member and plan.

What Great Plans Will Do Differently

The highest-performing Medicare Advantage plans are beginning to recognize that member experience is not just about reducing friction. It is about creating meaningful moments across the care journey—especially for high-need populations.

In this model, advance care planning is not a document completion exercise. It is an ongoing relationship-building process that:

• Engages members earlier in serious illness
• Creates clarity during uncertainty
• Builds trust through human support
• Produces information that actually changes care decisions

It is one of the few interventions that simultaneously improves experience, aligns care with member preference, and reduces avoidable utilization.

A New Model for Advance Care Planning

Imagine a member newly diagnosed with advanced heart failure.

Instead of waiting for a hospitalization or a care management referral, they are invited into a guided care planning experience from home.

They learn what to expect as their condition progresses. They reflect on their values and priorities. They identify the person they trust to make decisions on their behalf. And they receive support from a clinical navigator when questions arise.

When that member is later hospitalized, their preferences are already documented and available in the chart. Their family is not guessing. Their clinicians are not starting from scratch.

Care becomes more aligned, more consistent, and less reactive.

That is what scalable advance care planning looks like when it is designed as infrastructure rather than a one-time program.

Why This Is a Strategic Shift

When advance care planning is treated as infrastructure, it stops being a documentation exercise and becomes a continuous part of the member relationship.

It connects clinical insight, human support, and workflow integration into a single system that adapts as the member’s health changes.

And critically, it creates something most MA plans struggle to produce at scale:

A consistent, meaningful experience for the members who matter most to their clinical and financial outcomes.

The Bigger Opportunity

Medicare Advantage plans have spent years trying to improve member experience by optimizing administrative processes.

That matters. But it is not what members remember.

The experiences that shape loyalty, and increasingly, Star Ratings—are human ones.

The conversation that helped someone prepare for the future.
The navigator who stayed with them through uncertainty.
The confidence that their family or caregiver would know what to do when it mattered most.

Those moments build trust. They shape retention. And they increasingly influence financial performance.

The plans that recognize advance care planning as both a clinical strategy and a member experience strategy will not just improve quality scores.

They will build stronger, more durable relationships with the members who need them most.