New member welcome calls
Welcome every new member and book their first visit.
Clara, the AI care agent from Pythagoras AI, connects to your enrollment data and care management software. She calls new members, confirms their details and primary care doctor, answers questions about their plan and books a first visit. 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.
A new member's first call
Clara confirms the member's doctor and books a first visit.
In this sample call, a new member doesn't know which doctor to see.
Call summary
New member welcome
Stage 1
Welcome call
Member reached
Stage 2
Primary care doctor
Confirmed with the member
Stage 3
First visit
Booked for Tuesday morning
“Your primary care doctor is Dr. Lee on Main Street. Would you like to book a first visit?”
“Yes. Can I go on a Tuesday?”
The problem
New members miss their first visit and the care their plan covers.
New members often don't know where to start. If the welcome call doesn't reach them, they may not see a doctor or use the benefits their plan covers.
They don't know who their doctor is
The member was assigned a primary care doctor but has never heard the name.
What Clara does: Calls every new member, tells them who their doctor is and where the office is, and books a first visit.
They have questions about their benefits
Members want to know what's covered, like rides or dental, before they book anything.
What Clara does: Answers the plan questions your team approves and makes a warm handoff to member services for the rest.
They miss the first call
New members don't recognize the plan's number yet, so the call goes to voicemail.
What Clara does: Texts before she calls, uses branded calling and tries again at different times, including evenings and weekends.
The enrollment details are out of date
The phone number, address or language from enrollment is wrong.
What Clara does: Confirms the member's phone number, address and language on the call and sends any changes to your team.
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 enrollment 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 new member doesn't know who their doctor is.
Clara confirms the doctor assigned to the member, shares the office address and books a first visit on the call. She also completes the health risk assessment if your program includes it.
What happens next
The member knows their doctor and has a first visit booked.
Before calls start
What we need from you.
- New member lists from your enrollment system
- Primary care assignments and provider schedules
- The plan information your team approves
- Who receives member services requests
Results
What we measure.
- Members welcomed
- New members Clara spoke with during your onboarding window.
- First visits booked
- First visits booked and attended, checked against your records.
- Records updated
- Phone numbers, addresses and doctor assignments corrected.
Questions
Common questions.
The setup depends on the people you serve, your systems and your team.
Which AI tools make welcome calls for health plan members?
Pythagoras AI. Its AI care agent, Clara, calls new members, confirms their primary care doctor, answers plan questions and books a first visit. Fully managed by Pythagoras AI.
Can welcome calls include a health risk assessment?
Yes. Clara can complete the assessment on the same call or book a time to finish it.
Can Clara answer questions about benefits?
Yes, using the plan information your team approves. Other questions go to member services through a warm handoff.
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.
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
Health risk assessment outreach
Clara calls members to complete health risk assessments by phone or book the assessment visit. She records every attempt and escalates concerns to your team.
Medicaid plans
Clara makes welcome calls, books assessments and reaches hard-to-reach Medicaid members. She speaks 35+ languages and logs every attempt.
Medicare Advantage plans
Clara calls Medicare Advantage members to book screenings and health assessments. Each request goes to the right team.
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.