This paper explores potential operational implications and strategic approaches to adapt to the significant changes in the Medicare Star Rating system. The healthcare industry is experiencing rapid evolution, characterized by regulatory changes and heightened competitiveness. We cover a range of potential ideas that MAOs can use to respond to the changes in the Star Rating system, by reassessing and modifying their operational practices to counter the potential negative impact on their financial stability. The paper is organized as follows: 

• Background: Evolution of Medicare Advantage Star Rating System
• Case study: Preventive services (Part C)
• Deep dive: The appointment-based model (Part D)