Care Management

AI voice outreach — in any language, at 75% less cost.

At volumes never before possible, achieve outreach engagement that human-staffed call centers and care managers just can’t do alone.

24/7 Outreach: across voice, SMS, and email. Connect to your members when they’re actually available to talk. Greet them in their own language. Use their preferred communication channel.

Scale your outreach without adding headcount:

• HRA and assessment outreach
• Preventive services and medical screening reminders
• HEDIS and Star gap closures
• Post-discharge follow-ups
• Chronic condition check-ins
• Medication therapy management

Seasonal surge bottlenecks won’t affect how you hit those SNP and HRA deadlines anymore. Raise your Star ratings by closing screening and adherence gaps, and reduce readmissions with timely post-discharge contact.

ALWAYS HUMAN-IN-THE-LOOP. Every conversation is logged, compliant, and escalated to a human when needed — at roughly 75% lower cost than traditional outreach. It can also acknowledge case receipt and request missing documents across CM, UM, and A&G.

Live risk tiers from claims, EMR, and HRA — not last year’s snapshot.

Continuous stratification of your claims, EMR, and HRA data. With the Identification & Stratification agent, you can assign dynamic risk tiers across your member population. You’ll no longer need to rely on static, annual stratification.

Access current real-time data, anytime.

When applying CMS-HCC or other models, the Identification & Stratification agent flags rising-risk members. Now you can flow resources to those who need them by getting a timely picture of members whose trajectory has changed since the last assessment.

Use it to:

• prioritize caseloads by current clinical reality
• identify disease-management and complex-case members earlier
• support accurate risk adjustment
• show regulators a systematic, current methodology

Plans using dynamic stratification intervene months earlier than annual snapshots allow.

Full member clinical picture, summarized in seconds.

Find the clinical story with complete, real-time data. The Clinical Summary Agent builds clinical summaries from every available source:

• Claims
• UM history
• care management
• call notes
• medical records

Clinical summaries are tailored to whoever needs them:

• care managers preparing outreach
• medical directors reviewing UM cases
• A&G coordinators assembling appeal files

Summaries are CMS Interoperability compliant and cut preparation time by as much as 80%. Eliminate hours of clinical staff rebuilding member histories from fragmented systems. Now you can give every reviewer a consistent evidence picture, and accelerate any workflow that starts with “What’s the clinical story here?”

CMS-mandated care plans in under 5 minutes.

The ICP Agent auto-generates federally mandated Individualized Care Plans:

• goals
• barriers
• interventions
• milestones
• actions

Using member assessment data — claims, clinical history, and risk profile — ICPs have never been easier or faster to generate. What takes a care manager 60–90 minutes can be completed in under 5 minutes, with the care manager reviewing and personalizing, instead of starting from a blank template.

For Special Needs Plans, it’s the difference between ICP timeliness compliance and CMS findings: every enrolled member gets a compliant plan within required timeframes, regardless of volume. For care management leaders, it converts documentation hours back into member-facing time.

Any device, one platform — real-time monitoring.

Catch deterioration before it becomes an ER visit. Turn any remote monitoring device into real-time care workflows:

• blood pressure cuffs
• glucometers
• scales
• pulse oximeters

Monitoring between touchpoints allows context-based alerts when readings trend toward concerning conditions. The agent feeds data directly into care workflows and can open new revenue through CPT 99453–99458 billing.

Use the RPM agent to monitor:

• congestive heart failure (CHF)
• HF
• diabetes
• hypertension
• COPD

The RPM agent workflow monitors populations continuously rather than episodically, so you can catch deterioration before it becomes an ER visit or readmission. It allows you to build an RPM program that generates reimbursement rather than pure cost. For delegated or value-based arrangements, it provides the between-visit visibility that makes total-cost-of-care management real.