Boosting Star Ratings & CAHPS with GetSetUp’s AI Assistant & AI Search

AI-Driven Engagement for Higher Star Ratings

For stakeholders of Star Ratings, improving Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores, Healthcare Effectiveness Data and Information Set (HEDIS) performance, and member engagement is mission-critical. GetSetUp’s AI Assistant & AI Search is a proven solution that helps Medicare Advantage plans enhance member experiences, increase preventive care uptake, and improve satisfaction scores, which are all key drivers of Star Ratings performance. GetSetUp has spent over four years teaching older adults the most important skills needed to live 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, 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.

How It Works: Smart, Personalized Guidance

Older adults often struggle to navigate their benefits, impacting plan satisfaction and preventive care utilization. Helen, our AI assistant, eliminates this friction by providing instant, personalized answers to benefit-related questions, guiding members through key topics with structured conversation prompts such as:

📌 “What changed in my plan this year?” → Helps members engage with their Annual Notice of Change (ANOC), reducing dissatisfaction from surprise cost increases.

📌 “Tell me about my benefits.” → Surfaces underutilized supplemental benefits (e.g., Uber rides to medical visits), improving access to care.

📌 “What preventive screenings should I get?” → Encourages timely HEDIS-measured screenings like mammograms and flu shots.

By embedding AI support within plan portals, members get fast, accurate answers, leading to increased engagement and higher member satisfaction.

Member Story: How AI Support Helped Maria Take Control of Her Health

For example, Maria, a 72-year-old Medicare Advantage member, had never scheduled a preventive screening before. When she logged into her plan’s portal to check her coverage, she saw Helen’s prompt: “Want to learn about your preventive care benefits?”

Curious, Maria clicked it. Helen guided her through a conversation, explaining her no-cost preventive screenings and reminding her that she was overdue for a mammogram. With just a few more clicks, Maria scheduled her screening through her plan’s preferred provider network. A few weeks later, the test detected an early-stage abnormality, allowing her to seek treatment before it became a serious health issue.

Because of this proactive AI-driven engagement, Maria took advantage of a benefit she didn’t even know she had, improving her health outcome while also boosting her plan’s HEDIS preventive care scores.

Why This Matters for Star Ratings

This may seem like a small change, but it can have a huge benefit for plans who implement effectively these AI tools into virtual programming and other digital benefits can see great improvements.

✅ Improves CAHPS Scores: Members feel more informed and supported, improving plan satisfaction metrics.

✅ Boosts Preventive Care & HEDIS Measures: Proactive reminders drive engagement in annual wellness visits, screenings, and chronic care management.

‍✅ Reduces Support Calls: AI guidance decreases reliance on call centers, improving customer service satisfaction ratings.

‍✅ Increases Benefit Utilization: More members use fitness, transportation, and social benefits, leading to better health outcomes and retention.

Customizable AI for Maximum Impact

AI Assistants are customizable and can help point members to resources that will help them. They can help gather data and information and reduce support reliance. With simple customizable AI integrations and digital tools health plans can reap large returns. These integrations, to name a few, include:

🎯 Up to 40 Custom Prompts to align with Star Ratings priorities.

🎯 Seamless Integration within member portals and apps.

🎯 Data-Driven Insights on member interactions to optimize outreach.

The Future of Star Ratings Improvement is AI-Driven

With GetSetUp's AI-powered guided discovery, Medicare Advantage plans can proactively engage members, improve CAHPS and HEDIS scores, and drive better health outcomes. Ready to elevate your Star Ratings strategy? Let’s talk.