Orchestrators / Payor / AI STAR Rating Improvement
Star Ratings are earned all year—not when the survey arrives.
Poor scores often begin with small problems that go unresolved: a confusing bill, an unexplained denial, or a call that led nowhere. Care gaps persist for the same reason. Members who do not respond to reminders often face a real barrier, such as fear, cost, transportation, or not having a doctor.
Traditional outreach addresses one issue at a time. A member may receive a mammography call while several other care gaps and service concerns remain untouched.
AI STAR Rating Improvement helps plans engage members throughout the year, understand what is getting in the way, and address multiple needs in one conversation—while there is still time to make a difference.
That means a better member experience, earlier screenings, fewer unresolved care gaps, and stronger Star performance.
Super Power: Omni-topic. A human gap-closure call is topic-locked because the caller is trained on one measure; the agent closes several HEDIS gaps in one conversation, then asks the CAHPS question nobody gets to — what went wrong last time — and fixes it before the survey rather than after. Average call duration has risen from 5.5 to 9.5 minutes, because members stay engaged when the call is actually about them.
Features:
Potential features:
