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Who We Serve, Hospitals & Health Systems

Payer & Health Plan Solutions

Care Gaps Stay Open When Members Don’t Follow Through
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The Challenge

The Problem You Already See

Quality measure targets, RAF score accuracy, and total cost of care all depend on the same thing: whether members complete the next step. We deploy activation-trained agents who address the real reasons members don’t follow through: confusion, fear, logistics, and competing priorities. Our platform segments by payer type, SDOH profile, and clinical risk so every interaction drives toward a completed action.
Root Cause

As Healthcare Experts, We See the Deeper Problem

  • Payers invest heavily in member outreach. Letters, portals, automated reminders, digital nudges. The volume of communication is high. The conversion to completed action is low.

The core issue: most outreach programs measure whether the message was sent, not whether the member did anything about it. A care gap reminder that goes to a member who doesn’t understand what the gap means, can’t get transportation to the appointment, or is managing three other competing priorities produces the same outcome as no outreach at all.

Fifty percent of non-compliance and non-adherence stems from social determinants of health. That means half the time a member fails to close a care gap, the reason has nothing to do with willingness. It has to do with barriers the outreach program never asked about and can’t resolve through a letter or a portal notification.

For plans managing attributed populations, the math is direct. Every unclosed care gap is a missed quality measure. Every inaccurate RAF score is lost revenue. Every avoidable ED visit is excess cost. And every member who leaks out of network is a permanent reduction in the value of the attributed life. These aren’t separate problems. They’re the same problem expressed in different line items: members intend to act but don’t complete the action.

PROVEN WITH HOSPITALS

30% CHF Readmission Reduction via Post-Discharge Activation

A large clinically integrated network with 12,000 attributed members achieved 40% activation rate for ACO provider appointments and a 5× activation rate increase within 90 days.
30%
Readmission reduction
99.4%
QA pass rate
9
Behavioral science techniques
24/7
Coverage available

Ready to close the gap between outreach and action?

Schedule a consultation and we’ll show you how activation-trained agents can move your quality measures, RAF capture, and member retention.

Schedule a Consultation