All use cases

Prevent / Care

Post-visit aftercare and coverage outreach

The visit is over, the results are back, and the renewal is due in three weeks — the agent runs the follow-through a small nav team can't reach to every member.

Get aheadClose the loopTime-based triggerSystem triggerSMSVoiceEmailWhatsAppHealth & Telehealth

What it does

The care that decides whether a member stays well and stays enrolled happens between visits, and it is exactly the work that overflows a navigation team: post-visit check-ins, delivering lab and imaging results, reminding members before coverage lapses, and collecting the annual forms that keep them eligible. A small team can place a few hundred outreach calls a day and still miss most members, so check-ins get skipped, results sit undelivered, and coverage quietly expires. The agent runs this aftercare across SMS, voice, email and WhatsApp — checking in after a visit, prompting members to view results that a clinician has released, flagging an approaching coverage deadline, and collecting forms on schedule. It carries continuity of care without giving clinical advice: anything that looks like a worsening symptom or a red flag is routed straight to a clinician.

How it works

  1. 1
    Trigger. a care-lifecycle event fires — a completed visit due a check-in, a result released by a clinician for delivery, a coverage-expiry date approaching, or an annual form coming due.
  2. 2
    Decision. the agent reads the member's record, recent contacts and channel preference, decides the right outreach and timing, and applies the safety policy — it surfaces and prompts, it does not interpret clinical findings or advise on treatment; a judge gates the message before it sends.
  3. 3
    Action. it reaches out on the member's preferred channel — a gentle post-visit check-in, a prompt to view a clinician-released result through the secure portal, a coverage-renewal reminder with the next step, or a request to complete the annual form — and captures the response.
  4. 4
    Follow-through. completed forms and acknowledged reminders write back to the record; a member who reports a worsening symptom or trips a red-flag rule is escalated to a clinician immediately; stale outreach is cancelled once the action is taken, and the nav team keeps the conversations that need a human.
Example
AgentHi — it's been a few days since your appointment. Just checking in: how have you been feeling since the visit? Your provider has also released your recent lab results, and you can view them securely in your portal here.
MemberMostly okay, but the swelling in my leg has actually got worse since I saw the doctor.
AgentThank you for telling me — worsening swelling is something a clinician should look at promptly. I'm not able to assess it myself, so I'm connecting you to our care team right now and flagging it as urgent. Please stay on this thread.

Configuration

How the agent is wired for this use case.

Triggera visit_completed / result_released / coverage_expiring / annual_form_due event from the care-management or EHR system.
Tools & actions
  • Care-management system · read the member record, visit history and care plan to time and target outreach
  • Patient portal · surface a clinician-released result via a secure link (deliver access, never interpret the finding)
  • Coverage / eligibility system · read the coverage-expiry or renewal date and the required next step
  • Forms service · send, collect and file the scheduled annual form, then write completion back
  • Clinician escalation queue · route any red-flag or worsening-symptom report to a clinician with the member context
  • Messaging channel · run check-ins, result prompts and reminders on the member's preferred surface
Autonomycheck-ins, result-availability prompts, coverage reminders and form collection run unattended under judge gating. The agent gives NO clinical interpretation, diagnosis, dosage or treatment advice — clinical content is detect-and-escalate only, and any red flag hands off to a clinician.
Channelssms · voice · email · whatsapp
Escalationany worsening-symptom report, red-flag indicator, or clinical question beyond logistics escalates immediately to a clinician with full member context.

What you need

The inputs this use case runs on. Your channels stay yours; the agent supplies the judgment.

Signals

completed-visit events, clinician result-release events, coverage-expiry and renewal dates, annual-form-due schedules, member responses and any symptom reports

Data

member record and care plan, contact and channel preferences and consent, coverage status, persistent memory of prior outreach and what was already actioned

Guardrails

the agent surfaces and prompts only — no diagnosis, dosage, or treatment advice; red-flag and worsening-symptom language is detected and escalated to a clinician; results are delivered via secure access, not summarized clinically; consent and frequency caps; stale-outreach cancellation once the member acts; full audit of every contact

Metrics it moves

  • contact-ratethe routine aftercare a small navigation team cannot scale to every member runs without adding headcount
  • adherenceup: members complete forms, view results, and renew coverage on time instead of letting each step slip
  • csatup: members feel followed up with between visits, and genuine clinical concerns reach a clinician fast

Related use cases

Engage / Lifecycle

Proactive health-coach companion

the ongoing in-program coaching companion, distinct from event-driven aftercare

Prevent / Care

Clinical red-flag detection and safe escalation

the safe-escalation pattern this outreach hands off to

Engage / Lifecycle

Test-result interpretation agent

the clinician-grade reading of a single result, beyond mere delivery

See it on your own customer journey

Bring one drop-off, one churn cliff, or one silent segment. We will show you what a proactive agent with memory and judgment does with it.

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