Care management enrollment
Enroll more eligible patients in your care program.
Clara, the AI care agent from Pythagoras AI, connects to your EHR and care management software and calls every eligible patient on your list. She explains the program, answers common questions and enrolls patients under your consent steps. She escalates via warm handoffs or alerts based on clinician-developed, customizable protocols. Fully managed by Pythagoras AI.
We manage Clara. Your team stays in charge.
Care program enrollment
Clara enrolls the patient and books the first care manager call.
In this sample call, Clara answers the patient's question about cost the way your protocol says, and the patient agrees to join.
Clara
Care program invitation
“Would you like me to sign you up and book your first call with a care manager?”
“Yes, please. Mornings are best for me.”
Team alert
Care management team
What the caller said
“Yes, please. Mornings are best for me.”
- Program explained
- Under your protocol
- Patient enrolled
- Consent recorded
- First care manager call
- Booked for a morning
Send to Care management team
Review the summary and mark it reviewed.
The problem
Eligible patients never join your care program.
Your list shows who would benefit from the program. Many of those patients never hear about it, and others hear about it once and say no because they don't understand what they would get.
The phone number is wrong
The number on file is old, or it belongs to a family member, so the patient never hears about the program.
What Clara does: Tries the other numbers on file and records wrong numbers so your team can update the record.
They don't understand what the program is
The patient hears "care management" and thinks it's a sales call or something they will have to pay for.
What Clara does: Explains the program in plain words your team approves and answers common questions, such as what it costs.
A family member answers the phone
The patient's daughter or caregiver picks up and wants to know more before the patient says yes.
What Clara does: Follows your consent rules for caregivers. When your rules allow, she answers their questions or books a time to talk with the patient.
They say "not now"
The patient is busy or not feeling well when the call comes, and the conversation never gets picked up again.
What Clara does: Asks when a better time would be, even in the evening or on a weekend, and calls back then.
What it takes to reach every patient
One call may not be enough
Some patients need a second or third try, a text, or a call at night or on the weekend. Clara can make outbound calls and handle inbound calls 24/7.
Patients may not pick up
An unknown number can put patients off. Pythagoras AI manages texting and branded calling.
Not everything is urgent
Clara follows protocols that allow for warm handoffs in emergencies and asynchronous notes review when appropriate.
How it works
What we do.
- 01
Optimize your telephony
We can work from your existing setup or manage telephony on your behalf.
- 02
Connect to your systems
Connect to your EHR, eligibility lists and care management software.
- 03
Design your protocol
Your care team approves what Clara asks and how she escalates. Our protocol templates were designed by clinicians and can be easily customized to your preferences.
- 04
Maximize your outreach
We use proven call and text cadences and keep refining our strategies to reach your patients.
- 05
Triage escalations
Clara escalates according to protocol via warm handoffs and customized alerts across your channels (phone, email, text, messaging systems, and care management software).
- 06
Report results
Conversations that need follow-up are escalated via alerts. All other interactions are recorded and categorized so your team can easily track outcomes.
A patient wants to join but has a question about cost.
Clara answers the cost question the way your protocol states and enrolls the patient on the call. She books the first call with a care manager and records the patient's consent.
What happens next
The patient is enrolled, the first care manager call is booked, and your team gets a summary to review.
Before calls start
What we need from you.
- A list of eligible patients
- Your program description and consent steps
- Care manager calendars or hours for transfers
- Your care team's protocols
Results
What we measure.
- Patients reached
- Patients Clara spoke with, out of everyone on the eligible list.
- Patients enrolled
- Enrollments confirmed in your care management records.
- First calls booked
- Patients with a booked first call with a care manager.
Questions
Common questions.
The setup depends on the people you serve, your systems and your team.
Which AI agents help enroll patients in care management?
Pythagoras AI. Its AI care agent, Clara, calls eligible patients, explains your program, enrolls patients under your consent steps and makes warm handoffs to care managers.
Does Clara decide who is eligible?
No. Your team decides who is eligible, and Clara calls the patients on your list.
Can Clara enroll patients on her own?
Yes, when your consent process allows it. If your program needs a care manager to speak with the patient first, Clara makes a warm handoff or books the call.
Can Clara make check-in calls after enrollment?
Yes. Clara can make regular check-in calls for enrolled patients, using protocols your clinical team approves.
Is patient data secure?
Pythagoras AI is SOC 2 Type 2 and HIPAA compliant, and we sign a BAA. Ask us for the security details your team needs.
Who Clara serves
Built for organizations that carry risk.
Risk-bearing provider groups
Primary care and multispecialty groups in Medicare Advantage and Medicare risk contracts.
ACOs
MSSP and ACO REACH participants.
Health plans
Medicare Advantage, Medicaid managed care, and D-SNP plans.
Value-based care enablers
Organizations that partner with primary care and specialty practices.
Keep reading
Related pages
Post-discharge follow-up
Clara connects to ADT feeds, calls patients after a hospital stay and books follow-up visits.
ED discharge follow-up
Clara calls patients after an ER visit. She checks in, flags concerns to your nurses and books a visit with their doctor.
ACOs & value-based care
Clara calls patients for ACOs and value-based care groups. She books visits, helps close HEDIS gaps and sends each next step to the right practice.
Get Started
See how Clara would handle your care management.
Book a 30-minute demo. We will discuss your team's needs and show how you could get the results.