Healthcare Client Story

Achieve Top CMS Star Ratings by Providing Accurate Information on Every Call, Every Time

One of the largest US healthcare plan providers achieved its optimal CMS Star rating with a modern knowledgebase, expert Star team, and innovative training using RealPlay™ platform bots and secret shopping teams.

99.4% information


98.9% <br class="hidden-xs hidden-sm" />


Peace of mind for high Stars

performance ratings

The challenge

Every year between February and May, the Centers for Medicare & Medicaid Services (CMS) secretly shop Medicare Advantage and Prescription Drug Plan Sponsors to help ensure healthcare consumers receive the best possible service and care.

When a May 2020 final rule from CMS pushed customer experience (CX) to the forefront of determining Star ratings, one of the nation’s largest health plan providers knew it needed to develop a strong, well-informed, and self-reliant workforce to ensure its Star performance.

Our solution

The large healthcare plan approached TTEC specifically to help prepare their internal teams to pass the Timeliness Study and Accuracy and Accessibility Study during the CMS secret shopping season, thus solidifying its top Star performance.

After assessing the status quo, our team sprang into action by first cleaning up the outdated, disorganized knowledgebase. Keeping the right information at associates’ fingertips was crucial to ensuring CMS secret shoppers – as well as potential plan members – would receive accurate information quickly.

We also assembled an expert Star team of empathetic associates dedicated to delivering flawless CX during the shopping surveillance season. Then, we deployed innovative technology to train, test, and perfect associate performance in safe environments with real-time feedback using RealPlay platform bots and secret shopping teams.

After “graduating” from the training programs, we deployed a team of real-life mystery shopping testers to ask three questions, time their responses, and allow associates to navigate the new knowledgebase’s functional ability. Our goal was to certify every single agent could handle any type of call from start-to-finish.

The results

Updating the knowledgebase and training associates with bots first, followed by human testers, provided them with tried-and-true skills and techniques to respond appropriately and in a timely manner all throughout the secret shopping season.

Internal reporting confirmed associates were consistently reaching 99.4% information accuracy on calls, and 98.9% accessibility. Armed with this crucial performance data, the plan entered the shopping season with confidence. All our hard work paid off when the plan achieved its optimal Star rating.

To this day, we continue to help the plan’s supervisors gain greater visibility into associate performance, quickly identify areas for improvement, and establish CX consistency in today’s competitive market to ensure optimal Star ratings to attract and keep loyal plan members.


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