ThoroughCare enrolls patients in care programs 6x faster with 5x the coverage per care manager.
An enrollment agent built on KORA turns chart review into a prepared, prioritized worklist so care managers can spend more time reaching patients.
- Program enrollment
- 30 days
- Down from six months
- Enrollment capacity
- 5x
- More enrollments per care manager
- Projected enrollment-rate lift
- 10–20%
- Targeted improvement
- Modeled annual capacity savings
- $100k–150k
- Per care manager; capacity value, not realized expense savings
Overview
Value-based care ties reimbursement to clinical outcomes and patient experience. Provider organizations must improve both while holding costs down, and alternative payment models keep raising the share of revenue tied to performance. Care management is how they get there. Chronic care management, remote patient monitoring, transitional care, and behavioral health integration each pay for clinical time with a patient between office visits, and that contact closes care gaps, improves adherence, and keeps patients out of the hospital.
ThoroughCare supports care management programs for more than 700 providers, including accountable care organizations, physician groups, health systems, home health agencies and pharmacies. The company built its platform around a repeatable model for growing those programs 10 to 15 times over, pairing bi-directional EHR interoperability, guided assessments, care planning and automated billing support with in-house clinical advisors. Growth on that scale runs through enrollment, and enrollment starts with the chart review that identifies who qualifies.
The challenge
Chart review is where enrollment stalls. To evaluate one patient, a care manager opens the chart and pulls problems, medications, recent labs and vitals, encounters, hospital discharges, screenings, insurance, and current enrollments. Then they test it all against eligibility and billing rules that differ across eight programs and change often. Then they apply exclusions, clinical priority, and the outreach plan. Fifteen to 25 minutes per patient, or roughly 33 hours for a panel of 100.
Risk scoring runs a second pass over the same charts. Pull each patient's ICD-10 codes, classify them against four code lists, count encounters by type, check HRA responses, calculate BMI, and score twelve categories. Another 10 to 15 minutes per patient. Another 20 hours per 100.
Time works against the care team throughout. Post-discharge transitional care windows carry hard deadlines, and a patient nobody reaches in time stops counting. Panels grow faster than review capacity, coverage varies based on who has hours that week, and eligible patients go unenrolled. ThoroughCare's growth model asks a care manager to read more charts than the day allows.
The solution
ThoroughCare set out to take chart review off the care manager's desk. Twenty minutes of eligibility work per patient adds up to a full day of review for every 25 charts, and every one of those days is time away from the phone with a patient. Meanwhile a qualified patient who waits for review is reimbursement nobody bills and a care gap that stays open. Moving that work to AI agents lets enrollment keep pace with panel growth.
ThoroughCare partnered with ACTAVA to build an enrollment agent on KORA. The agent runs in the background across the entire panel and follows the same sequence for every patient.
How the enrollment agent works
Swipe to see the full diagram
Step 1: Intake
It receives the set of patients to assess and works through them one by one.
Step 2: Consent first
It checks consent and contact eligibility before any clinical review, dropping anyone it should not contact and recording why.
Step 3: Clinical synthesis
It reads ThoroughCare through a read-only integration and assembles each patient's conditions, medications, labs, vitals, encounters, care transitions, screenings, insurance, and current enrollments.
Step 4: Eligibility and prioritization
It applies program-specific eligibility logic across all eight programs, then ranks patients with a prioritization model that weights clinical urgency and deadline-driven cases.
Step 5: Recommendations and outreach plan
It returns a recommendation for each patient naming the suggested programs, the reasoning, any billing prerequisites left to resolve, and a first-outreach plan.
One run covers hundreds of patients and picks up where it left off.
The agent recommends, and the care manager decides. Nothing reaches a patient until a person reviews it. Care managers work the ranked list, make the call, and document the care plan, applying the same clinical judgment as before to a prepared worklist instead of a raw chart.
The agent reads from ThoroughCare and never writes back, and the source record stays exactly as the care team left it. When data is missing, the agent flags the gap instead of filling it in. Every recommendation carries an audit trail showing which data drove which conclusion, and KORA scores eligibility accuracy and output quality before deployment and continuously after.
“At ThoroughCare, we're committed to empowering care teams to deliver high-quality, patient-centered care. Our partnership with ACTAVA has been instrumental — reducing administrative burden, automating time-intensive processes, and enabling care teams to operate more efficiently and effectively.”
The result
Eligibility assessment that took 20 minutes per patient now runs in the background across a whole panel. ThoroughCare enrolls patients in 30 days instead of six months, and a single care manager covers five times the enrollments they handled before. ACTAVA reports an 11x improvement in token efficiency through agent optimization, keeping cost per patient flat as panels grow.
ThoroughCare and ACTAVA modeled what that recovers. More than 50 care manager hours come back per 100-patient panel. A monthly workflow across 500 or more patients recovers significant annual savings in care manager capacity, and ThoroughCare is targeting a 10 to 20% lift in enrollment rates on top of that.
ThoroughCare changes the economics of care management by expanding care coordination to patients historically overlooked due to limited care manager capacity. By systematically screening entire patient panels and capturing post-discharge patients within the critical window, care managers can proactively engage patients at scale. The result is the 10- to 15-times growth that ThoroughCare's model is designed to deliver: more patients reached, more opportunities to intervene, and greater impact from every care management resource.
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