Automated Care Management Outreach
Engage high-risk members at scale with an AI-powered virtual care coordinator that automates follow-ups, improves adherence, and reduces avoidable readmissions—without increasing care team workload.
- Automated Patient Outreach at Scale
- Intelligent Symptom & Adherence Check-Ins
- Human-in-the-Loop Escalation
- FHIR-Based Care Coordination
Care Management Gaps Undermining Value-Based Outcomes
Payers (especially in value-based or managed care models) often run care management programs to coordinate services for high-risk members – e.g. post-hospital discharge follow-ups or chronic disease coaching. Currently this involves nurses or coordinators calling members, but outreach is labor-intensive and many patients are hard to reach consistently. Gaps in care (missed follow-ups, poor medication adherence) drive up costs (e.g. avoidable readmissions) and can hurt quality metrics.
Operational Inefficiency
- Nurses spend hours on routine outbound calls
- Outreach does not scale with growing member volumes
- Limited time remains for complex, high-risk cases
Inconsistent Member Engagement
- Members are often unreachable during working hours
- Follow-up attempts are missed or delayed
- Engagement varies widely across populations
Gaps in Care & Adherence
- Post-discharge follow-ups are frequently missed
- Medication and care plan adherence is inconsistent
- Early warning signs go unreported
Cost & Quality Impact
- Avoidable readmissions increase medical spend
- Poor outreach hurts value-based care metrics
- Quality scores and outcomes are negatively affected
Patient-Facing Engagement
Patient-facing – it directly engages health plan members on behalf of the care management team.
Member Facing Care Management Outreach
Health plan members interact with the system through AI-driven voice or chat outreach for post-discharge follow-ups, chronic condition check-ins, and medication reminders. The solution provides consistent support between visits while escalating high-risk responses to the care management team for timely intervention.
Automated Member Engagement for Care Management
The solution directly engages health plan members via conversational AI to deliver routine care management outreach at scale. This improves member responsiveness and continuity of care while allowing nurses and care coordinators to focus on members who require personalized, high-touch follow-up.
AI-Powered Virtual Care Coordinator
A conversational AI agent (voicebot or chatbot) can conduct routine outreach at scale. For example, an AI voice agent can call a recently discharged patient to check on recovery: it uses natural language understanding to ask about symptoms, remind them of medications, or prompt a follow-up appointment.
Members with chronic conditions could receive automated check-in calls that collect readings (like blood pressure or glucose) and provide personalized guidance. The AI flags any concerning responses for a human nurse to follow up immediately. This “virtual care coordinator” ensures no patient falls through the cracks between visits.
Members with chronic conditions could receive automated check-in calls that collect readings (like blood pressure or glucose) and provide personalized guidance. The AI flags any concerning responses for a human nurse to follow up immediately. This “virtual care coordinator” ensures no patient falls through the cracks between visits.
Seamless EHR Integration for Personalized, Coordinated Care
Yes. The agent can log data back into care management or EHR systems via FHIR CarePlan, Observation, or Task resources. It may also use FHIR to fetch patient health history to personalize the interaction (e.g. pulling last BP reading or medication list to discuss).
This supports care coordination by sharing data with providers if needed.
This supports care coordination by sharing data with providers if needed.
Scale Care Management Effortlessly Without Scaling Staff
Use an AI-powered virtual care coordinator to automate routine outreach, improve follow-up adherence, and flag high-risk members for timely nurse intervention—ensuring better outcomes without added operational burden.
