For a Director of Quality or Member Experience at a Medicare Advantage plan, the annual release of CMS STAR Ratings is more than just another performance review — it’s a defining moment. These scores don’t just measure service quality; they directly influence enrollment growth, brand credibility, and reimbursement potential. Plans earning 4 or more stars qualify for substantial Quality Bonus Payments (QBPs) and gain a competitive marketing edge. Hence, improving STAR ratings is a priority for Medicare Advantage plans.
But as CMS continues to increase the weight of member experience metrics—now accounting for over 57% of the total STAR Rating—the call center’s role has evolved from transactional to transformational. It’s no longer just about handling inquiries; it’s about shaping the very metrics that determine your plan’s success.
Our contact center is the heartbeat of our STAR performance. Every conversation with a member is an opportunity to earn—or lose—a star.
— VP of Member Experience, National Medicare Advantage Plan
A specialized Medicare Advantage BPO partner like Ameridial can directly influence these outcomes, transforming your contact center from a cost center into a strategic engine for improving STAR ratings for Medicare Advantage plans.
The Direct Line: How BPO Services Impact Key STAR Rating Domains
1. Elevating the Member Experience (CAHPS Scores)
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey accounts for a significant portion of your STAR score. Questions such as “Getting Needed Care,” “Care Coordination,” and “Customer Service” are directly affected by call center performance.
- First Call Resolution (FCR): According to JD Power, plans with high FCR see up to 30% higher CAHPS satisfaction scores. Ameridial’s HIPAA-trained agents specialize in resolving issues on the first call—reducing frustration and enhancing confidence.
- Empathy and Clarity: For Medicare members—many of whom are seniors navigating complex coverage—empathy matters. Ameridial trains agents in emotional intelligence and active listening, turning potentially stressful interactions into positive, memorable experiences.
Our agents don’t just close tickets—they open trust. Every empathetic exchange is a small win that builds long-term loyalty.
— Ameridial, Training Supervisor
2. Driving Medication Adherence (Part D Measures)
Medication adherence measures for diabetes, hypertension, and cholesterol management are among the most heavily weighted metrics. A proactive healthcare call center can directly improve adherence through timely, personalized outreach.
- Refill Reminders: Ameridial executes customized call, SMS, and email campaigns that remind members to refill prescriptions before their prescriptions lapse.
- Barrier Resolution: Agents don’t just remind—they resolve. They can assist with pharmacy transfers, prior authorization questions, or cost concerns that might otherwise lead to non-adherence.
A 2023 CMS report found that plans using proactive outreach saw a 12% increase in medication adherence and a corresponding boost in Part D STAR measures.
3. Closing Gaps in Care (Preventive Health Measures)
The “Staying Healthy” domain measures preventive screenings and vaccinations. These are often overlooked by members unless reminded—and this is where a BPO adds measurable value.
- Preventive Outreach: Ameridial’s care coordination programs contact members due for annual wellness visits, mammograms, flu shots, and colorectal screenings.
- Scheduling Assistance: Agents help book appointments and remove logistical barriers, ensuring members follow through—an essential factor in improving your “Getting Needed Care” and “Staying Healthy” metrics.
This proactive approach not only boosts STAR performance but also aligns with value-based care objectives by improving health outcomes and reducing costly readmissions.
4. Reducing Complaints and Improving Customer Service
CMS measures both Member Complaints About the Health Plan and Customer Service as distinct rating domains. Your BPO partner’s ability to manage these areas can make or break your rating.
- Effective De-escalation: Trained Ameridial agents are equipped to resolve issues before they escalate into grievances.
- Efficient Appeals Processing: Fast, compliant appeals handling ensures CMS timeliness standards are met while reducing regulatory exposure.
- Transparency and Reporting: Ameridial provides real-time dashboards that track call resolution times, sentiment, and complaint rates, giving Quality teams instant visibility.
A Forrester analysis found that reducing complaint volume by just 10% can improve a plan’s overall STAR Rating by up to 0.2 stars—a small margin that can mean millions in bonus payments.
The Onshore Advantage: Why Member Support Matters
In a sector where clarity and empathy are everything, the location of your call center is not a financial decision—it’s a quality one.
For Medicare Advantage members—many of whom are over 65—linguistic precision, shared cultural context, and time zone alignment foster better comprehension and trust.
With onshore operations across Ohio, North Carolina, and Florida, Ameridial ensures that every member interaction reflects the professionalism, security, and cultural understanding Medicare beneficiaries expect. Additionally, we offer the comfort of nearshore and offshore operations too.
You can’t quantify the comfort a member feels when they hear a familiar voice or accent, but you can see it in the STARs.
— Joanna Walter, VP of Healthcare Operations at Ameridial
Turning Member Support into a STAR Strategy
In today’s competitive Medicare Advantage landscape, every call is an opportunity to improve your STAR ratings. The right outsourcing partner isn’t just a vendor—they’re a strategic ally in your quality improvement plan.
By choosing Ameridial, health plans gain access to:
- HIPAA-compliant, U.S.-based member engagement teams
- Proactive outreach programs that close care gaps and improve adherence
- AI-powered analytics that track sentiment, FCR, and quality metrics in real time
- A 35+ year legacy of trusted partnerships with health plans and TPAs nationwide
When you invest in Ameridial, you invest in member satisfaction, regulatory excellence, and measurable STAR improvement.
Because in healthcare, better calls mean better care—and better scores.
