The Prioritization Gap Driving CAHPS Score Declines
Care coordinators working from flat Salesforce member lists contact whoever is next in the queue, not whoever is most likely to respond positively to a survey or most in need of care gap closure. With 150,000–800,000 MA members and a finite outreach window, the math matters: high-propensity responders who have open care gaps are worth far more per outreach hour than low-propensity members with clean records. When coordinators can't distinguish between them, CAHPS scores reflect that randomness. Manual outreach also generates no feedback data, so the same low-effectiveness sequences repeat quarter after quarter.
Daily Ranked Outreach Lists, Driven by Your Own Data
An AI Labor Company agent extracts CAHPS outreach prioritization logic from Arcadia care gap records and Salesforce interaction histories — learning which member profiles, contact patterns, and care gap combinations have historically correlated with positive survey responses and successful gap closures. Each morning, the agent re-ranks the active member outreach pool by a combined score: survey response propensity, care gap closure impact, and days remaining in the outreach window. Coordinators receive a prioritized list routed through Genesys or Salesforce, not a raw pull. Cotiviti measure-level data feeds into the gap closure tracking, and Tableau dashboards show closure rates by HEDIS measure so you can redirect attention to lagging areas in real time.
What a 0.3–0.5 Star Improvement Is Actually Worth
In Medicare Advantage, Star Ratings directly govern quality bonus payments and benchmark percentages — a half-star recovery at scale can represent tens of millions in annual revenue that wouldn't otherwise appear. This is one of the clearest revenue-growth levers in plan operations. Teams in this position typically see 60–80% of the manual prioritization work automated, with coordinators spending their time on the highest-value contacts rather than working through undifferentiated lists. The targeted outcome is a 0.3–0.5 Star improvement in CAHPS Getting Care Quickly scores, with the agent live and generating daily outreach lists in approximately 6 weeks — well inside a typical measurement-period window.
How does the agent know which members are most likely to respond positively to a survey?
It learns from your Salesforce interaction histories — which contact methods, timing, coordinator notes, and member profiles have historically correlated with completed surveys and positive responses. It's not a generic propensity model; it's built from your plan's actual outreach history.
Can this help with measures beyond CAHPS Getting Care Quickly?
Yes. The prioritization logic can be extended to any HEDIS measure tracked in Arcadia and Cotiviti. The initial deployment targets the specific measure that drove the Star drop, but additional measure workstreams can be added once the core outreach prioritization is running.
What prevents coordinators from reverting to their old list-working habits?
The agent integrates with Genesys and Salesforce to surface the ranked list inside the tools coordinators already use — it doesn't require them to open a new system. Tableau dashboards also give managers visibility into whether coordinators are following prioritization order, creating a natural feedback mechanism.