The Hidden Killer of STARS Performance: Administrative Overload.
STARS, Care Gaps, and the Future of Member Support: Why the Sickest Members Need Less “Engagement” and More Automated Help
For more than a decade, health plans have invested billions in apps, portals, care programs, outreach teams, nurse lines, incentives, chatbots, text reminders, and analytics platforms—all to improve STARS performance and reduce preventable utilization. And yet, the results remain stubbornly similar year after year:
the sickest members are still the hardest to reach, the most overwhelmed, and the least likely to engage with the tools plans place in front of them.
This isn’t because they don’t care about their health.
It’s because the system is asking too much of the people who have the least capacity to navigate it.
The Core Problem: Administrative Burden Is a Hidden Killer of STARS Performance
When you speak privately with members living with multiple chronic conditions, they all say the same things:
“I’m exhausted.”
“I don’t understand the apps or the mail I get.”
“I don’t know which doctor to call.”
“The system makes me feel dumb.”
“I’m overwhelmed and embarrassed.”
These emotions matter. Because STARS is not just a clinical measurement problem—it’s a human friction problem.
Medication adherence.
Post-discharge follow-up.
Managing diabetes, heart failure, COPD.
Screenings.
Refill timing.
Scheduling.
Transportation.
Symptom monitoring.
These tasks, which health systems treat as routine, are not routine for a vulnerable senior with pain, fatigue, anxiety, and mobility challenges.
They are heavy, frustrating, and often impossible to complete consistently.
The sickest members are not “unengaged.”
They are overloaded, ashamed, and stuck.
The New Reality: Plans Cannot Hire Their Way Out of This
Care-management staffing is expensive.
Telephonic outreach has diminishing returns.
SMS programs and apps hit 10–20% adoption.
And seniors overwhelmed with life simply do not log into portals unless forced.
Health plans need a new model:
Relieve the administrative burden, not add to it.
That’s where HealthAgent enters.
HealthAgent: Concierge Medicine at Scale
HealthAgent is the first platform to treat the administrative burden itself as the clinical bottleneck—and automate it away.
Instead of expecting members to navigate the healthcare system, HealthAgent navigates the system for them.
Let the Agent Do the Hard Work Members Hate
When a member says:
“I’m out of my meds,” the Agent refills them.
“I just left the hospital,” the Agent books the follow-up appointment.
“I don’t feel well,” the Agent runs protocol-based triage and escalates.
“I need to see a doctor,” the Agent schedules and arranges transportation.
“What should I eat?” the Agent provides disease-specific, protocol-aligned guidance.
The member doesn’t need to download an app, find a phone number, search a portal, or deal with insurance complexity.
The Agent handles the friction.
The member experiences the benefit.
This Directly Impacts STARS—Hard Metrics, Not Soft Promises
The combination of emotional trust + automated execution is powerful:
Medication Adherence: The Agent reminds, schedules, refills, and follows up.
Follow-Up After Hospitalization: Real-time post-discharge check-ins + automated scheduling.
Chronic Disease Management: Protocol-driven guidance tied to NCQA-aligned care routines.
CAHPS: Members feel supported and understood, improving satisfaction scores.
Avoidable ED Utilization: Earlier detection and proactive action reduce acute episodes.
STARS is won or lost not by massive technology stacks, but by the consistency of member action.
HealthAgent makes action effortless.
The Truth: Members Don’t Need “Engagement” Tools—They Need Help
The healthcare industry has been focusing on the wrong word.
Engagement is not the goal.
Empowerment is.
And empowerment comes from removing friction—not adding technology the member must navigate.
For the first time, payers can give every member a compassionate, intelligent, always-available companion who:
understands them
knows their health
reduces fear and confusion
and completes the actions that keep them healthy
This is Concierge Medicine at Scale, powered by automation, empathy, and measurable outcomes.
STARS lift follows naturally.
