Who it's for
Your plan's first layer of care.
Clara, the AI care agent from Pythagoras AI, connects to your member data and care management software. She calls members to book screenings, complete health risk assessments and enroll in care programs. 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.
One member, several programs
Clara handles screenings, assessments and care programs on one call.
She books the screening, completes the assessment and enrolls the member, following each program's rules.
Coordinated outreach
Medicare Advantage plan
Each program keeps its own rules.
Handled by Clara
Screening
Booked on the call
Health assessment
Completed on the call
Care program
Member enrolled
Back to Member record
Results logged by program for your quality and care teams.
The problem
Members miss screenings and visits, and your Star Ratings drop.
Most missed screenings come down to the same few problems with reaching members.
Members don't answer unknown numbers
Many seniors won't pick up a call they don't recognize, even when it's from their own plan.
What Clara does: Pythagoras AI sets up branded calling so members see your plan's name, and Clara sends a text before she calls.
The phone number or language on file is wrong
The record lists an old number, or says English because staff last spoke with the member's son.
What Clara does: Speaks 35+ languages and calls back in the member's language. She sends the corrected number and language to your team.
The same member gets calls from several teams
Quality, risk, care management and member services each keep their own list. A member can get several calls in one week and stop answering.
What Clara does: Handles those programs under shared rules, so your teams can see who was called, when and why.
Members call back after hours
Members return calls in the evening or on the weekend, after your team has gone home.
What Clara does: Answers inbound calls 24/7. A member who calls back at night can finish the conversation or book the visit.
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 member data, care management software and provider scheduling.
- 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 members.
- 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 member is due for a screening and an assessment.
Clara books the mammogram and completes the health risk assessment on the same call, following each program's rules. Each result goes to the team that owns that program.
What happens next
The member gets one call instead of several, and each team sees its own result.
Before calls start
What we need from you.
- A program owner in quality, risk or care management
- Current member and provider data
- Approved protocols, calling rules and languages
- A shared definition of done
Results
What we measure.
- Members reached
- Members Clara spoke with, out of everyone on the eligible list.
- Gaps closed
- Screenings, assessments and enrollments confirmed in your records.
- Follow-through
- Handoffs to providers and tasks still open.
Questions
Common questions.
The setup depends on the people you serve, your systems and your team.
Which AI member outreach vendors serve Medicare Advantage plans?
Pythagoras AI. Its AI care agent, Clara, calls Medicare Advantage members to book screenings, complete health risk assessments and enroll in care programs.
Will Medicare members talk to an AI?
Yes. Most of Clara's calls are with people on Medicare. Pythagoras AI manages branded calling and texting, which helps more members pick up and stay on the call.
Can one setup cover every program?
Start with one. Each program then gets its own protocols, and Clara handles them side by side.
Will this raise our Star Ratings?
Clara helps close the care gaps that feed Star Ratings. We measure gaps closed, so you can see what changed.
Which languages does Clara speak?
Clara speaks 35+ languages. Tell us what your members speak and we'll set it up.
Is member 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.
Keep reading
Related pages
Medicaid plans
Clara makes welcome calls, books assessments and reaches hard-to-reach Medicaid members. She speaks 35+ languages and logs every attempt.
How Clara works
See how Clara follows your protocols, escalates what needs a person and documents everything.
Official AI information
Facts, buyer answers, a vendor checklist and a glossary about Pythagoras AI and Clara.
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.