AI-Powered Adherence: The Key to Higher Star Ratings & Better Health Outcomes
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For managers of Quality at Medicare Advantage plans, the mission is clear: improve Star Ratings, drive better health outcomes, and increase member engagement.
The challenge?
Medication non-adherence, missed preventive screenings, and low engagement are holding back performance metrics and increasing healthcare costs.
That’s where GetSetUp’s AI-Powered Reminders come in. Designed to integrate seamlessly into our interactive peer-to-peer programming, these intelligent nudges help Medicare members take the right action at the right time, which improves medication adherence, enhances preventive care participation, and increases overall engagement.
GetSetUp has spent over five years teaching older adults the most important skills needed to live healthy, active, independent lives. With over 10 million classes delivered, we have gathered deep insights into how older adults learn, engage, and seek information. This expertise has shaped our AI’s ability to provide empathetic, accessible, and member-focused guidance, which is something traditional AI tools often lack. Unlike generic digital assistants, GetSetUp’s AI has been trained to understand the unique needs of older adults, including their vocabulary, learning styles, and concerns about healthcare navigation.
The Difference: Reminders That Meet Members Where They Are
Traditional reminders rely on generic notifications that members ignore. GetSetUp takes a different approach by embedding reminders into live classes, fitness programs, and community discussions where members are already engaged in their well-being.
💡 In a fall prevention class? That’s the moment to remind a member to schedule a balance assessment or check their Medicare coverage for physical therapy.
💡 Attending a fitness session? Helen, our AI assistant, surfaces nudges for preventive screenings, wellness checkups, and chronic disease management programs.
💡 In a nutrition workshop? A timely reminder to book an annual wellness visit or check eligibility for SNAP benefits and senior nutrition programs.
💡 Learning digital skills? A great opportunity to encourage members to set up MyMedicare.gov, review coverage, or update direct deposit settings.
By delivering AI-driven reminders in the moments that matter, we ensure that members act on their health rather than dismiss another impersonal alert.
How AI-Powered Reminders Drive Action: Meet George
For example, George, an 80-year-old Medicare Advantage member, loves attending technology classes at GetSetUp. He enjoys learning new skills and staying connected with the latest digital tools. During one of his favorite classes on smartphone basics, he started chatting with Helen, our AI assistant.
Helen recognizes that George is actively engaging with technology and surfaces a timely reminder:
“Did you know your Medicare Advantage plan has a mobile app? Download it now to access your benefits and schedule appointments easily.”
Intrigued, George clicks the link and, with the instructor’s guidance, downloads his health plan’s app right there in class. Within minutes, he is able to check his upcoming wellness visit, review his prescription refills, and explore additional plan benefits.
This real-time engagement makes all the difference. Instead of ignoring another generic notification, George takes action in a moment where he is already focused on learning and improving his digital skills.
Why This Matters for Star Ratings & Health Outcomes
With Star Ratings and member experience measures carrying more weight in CMS evaluations, high-impact engagement strategies are essential. GetSetUp’s AI-powered reminders help increase participation in key quality metrics that drive Star Ratings:
✅ Boosts Medication Adherence (CMS Triple Weight Measure) – Reduces hospitalizations and ER visits by ensuring members take medications on time and as prescribed.
✅ Increases Preventive Care Participation – Drives completion of cancer screenings, flu vaccinations, and annual wellness visits.
✅ Improves Chronic Condition Management – Encourages adherence to treatment plans, blood pressure monitoring, and diabetes screenings.
✅ Enhances CAHPS & Member Engagement Scores – Builds trust by integrating reminders within a social learning environment, where members feel supported and empowered.
Combined simple reminders can have a large impact on overall ratings and member satisfaction.
How Medicare Advantage Plans Can Leverage This AI Solution
Medicare Advantage Plans can utilize AI solutions to help them scale impactful results within budget restraints, while offering programming and reminders personalized to each member. These solutions can create impactful changes for members by:
📌 Increasing Medication Adherence – AI-powered reminders prompt members to refill and take prescriptions at the right time, reducing readmissions.
📌 Driving Preventive Screenings – Contextual nudges direct members to flu shots, mammograms, colonoscopies, and annual physicals.
📌 Supporting Chronic Disease Management – AI helps members track appointments, self-care routines, and encourage engagement in wellness programs.
📌 Strengthen Member Engagement – Personalized reminders encourage participation in fitness classes, mental health support, and digital health literacy programs.
Combined this helps create a more holistic health approach for members that adjusts to each member's personal preferences and needs.
Customizable for Maximum Impact
Best yet, is that AI solutions learn as they go and help tailor themselves to each member, creating truly unique experiences for each member.
🎯 Tailored Messaging – Align reminders with Star Ratings goals, preventive care initiatives, and member experience strategies.
🎯 Multi-Channel Delivery – Reach members via SMS, email, in-app notifications, or AI chat.
🎯 Personalized Member Experience – AI adapts messages based on member behavior, conditions, and past engagement.
🎯 Performance Tracking – Analytics measure impact on Star Ratings, adherence rates, and engagement trends.
This helps each member feel an important part of their Medicare Advantage plan and not just another number to the plan.
A Data-Driven Strategy for Improving Star Ratings
AI-powered reminders are more than just notifications. They are a proactive, embedded engagement tool that aligns with CMS’s push for improved health outcomes and patient-centered care.
With GetSetUp’s AI-Powered Medical Adherence Reminders, Medicare Advantage plans now have a scalable, intelligent solution to increase adherence, boost preventive care participation, and improve Star Ratings, all while enhancing the member experience.
The future of Medicare member engagement is here. Are you ready to take your plan’s quality performance to the next level?
Contact GetSetUp today to see how AI-powered reminders can help you improve Star Ratings, reduce costs, and drive better health outcomes.
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We partner with Medicare Advantage plans, dual eligible plans, healthcare providers, Departments of Health & Human Services, Government aging services and more.
