Star Ratings are harder to maintain — and more critical than ever.
If you’re leading a Medicare Advantage plan, you know the stakes. Drop below four stars and funding, member retention and trust all take a hit. But there’s good news: smarter, more personalized member engagement can turn things around.
Why Star Ratings slip — and what’s at risk
Star Ratings are won or lost on the margins. The hardest-to-reach members can make or break your scores. Overlooking them can lead to lost points, reduced funding and eroded member trust.
Traditional outreach often misses key groups:
Dual-eligible individuals
Rural residents
Non-English speakers
Seniors who aren’t tech-savvy
To protect your Star Ratings, outreach must evolve — because every member counts.
Why traditional outreach falls short
According to a Zelis survey* of 1,100 health plan members:
30 percent of members cite communication accuracy and clarity as key drivers of dissatisfaction
16.7 percent of respondents say proactive assistance and communications would improve their experience.
Even though nearly 80 percent rate their overall healthcare experience and confidence levels as high, many still feel anxious choosing providers, understanding costs or reviewing bills. The root causes? Limited transparency and a lack of personal support.
Generic campaigns and one-size-fits-all incentives are no longer enough.
To move the needle, plans must shift from broad outreach to meaningful, personalized engagement.
What actually works for member engagement
Winning plans use multichannel, hyper-personalized strategies — text, phone, mail, in-person visits and community partnerships. Cultural sensitivity and real-time feedback are key to driving meaningful outcomes.
Smart strategies can look like:
Segmenting members by risk, eligibility and engagement history
Tailoring outreach to member preferences and demographics
Using incentives and culturally relevant messaging
Tracking engagement and adjusting tactics in real time
How to activate your offense
Most plans have mountains of data — but struggle to know where to start. Focus your resources where they’ll have the biggest impact:
Identify high-weighted measures with low performance
Map provider performance to measures that affect ratings
Prioritize interventions based on ROI potential
What leadership moves drive ratings
Success takes more than strategy — it demands agile leadership and strong cross-functional collaboration. Start by:
Sharing dashboards to boost transparency and speed up decisions
Empowering individuals with defined roles and accountability
Staying flexible to pivot quickly with CMS updates
Above all, champion member-centered care and invest in modern infrastructure. These moves help deliver better outcomes — and keep you ahead of change.
The solution: Personalization at scale
Health plans need practical, scalable solutions to reach underserved populations and improve member experience.
Look for solutions that:
Personalize outreach at scale
Connect with hard-to-reach members through tailored actions, rewards and multichannel communication
Member engagement is key to improving Star Ratings and program performance. CMS changes require new strategies for quality and experience. The key to strengthening your programs is proven, tech-enabled outreach.
Ready to win the ratings game?
Don’t let hard-to-reach members drag down your scores.
Explore our latest eBook for proven strategies, real-world examples and actionable insights to help you improve your Star Ratings — starting today.
*Zelis proprietary research
