Care management can't scale
on headcount anymore.
Caseloads keep climbing against a workforce that keeps shrinking. Orchestrate agents across longitudinal care work, evaluate them against your operational and regulatory standards, and deploy with the record an audit demands.
Headcount stopped being the answer. A general-purpose model isn't one either.
Care coordination, patient access, and revenue cycle work eat enormous staff hours and shape care directly. Administrative work is healthcare's biggest AI opportunity. It also breaks generic agents, which stumble the moment a task demands reasoning through dense managed care policy.
How we test the best models
Researchers at Stanford, Johns Hopkins Medicine, Yale, and Salesforce AI Research reviewed actAVA χ-BENCH.
- 28%
- Leading frontier agents finish this share of complex care management tasks on the first try.
- <8%
- Fewer than 8% keep succeeding when we run the same task again. Most wins do not hold.
- 200+
- Tools span 21 healthcare applications, with tasks grounded in real managed care policy.
What you build around the model decides whether an agent is deployable.
Every agent needs scaffolding around its model. Which systems it reaches, which policies it follows, what order it works in, and who signs off. That scaffolding is the harness, and it changes by workflow. In testing, one model performed reasonably inside one harness and failed outright inside another on the same task. Most failures traced back to dense policy, not hallucination or broken integrations. The harness determines the outcome.
Read the χ-BENCH studyThe actAVA solution
Care management needs agents built for work that runs for months,
and a model that learns your policies.
Build, evaluate, and optimize every care management agent
Build agents that work over chat, voice, text, and in the background, then orchestrate them into longer workflows. HIPAA rules, access controls, and audit logs apply to every one. Each agent is tested before it goes live, improves from finished work under staff review, and reports what it costs and the impact.
Explore KORARun any frontier model, and own the intelligence underneath it
Run CURA, frontier models, or both, and swap the model without rewriting eligibility or risk logic. KORA orchestrates the care management workflows and CURA owns the intelligence underneath them, trained on your plan rules and your members inside your own cloud environment at a lower cost.
Explore CURADeploy 20+ pre-built care management agents on day one
Start free with agents for HCC chart review, prior authorization, care gap outreach, and transitions of care. HIPAA controls, human-in-the-loop oversight, and EHR and payer integrations ship wired in, so a care management leader can deploy through a conversational interface without engineers.
Explore the libraryThe agent library · Value-based care
23 care management agents, ready to deploy
These agents span risk adjustment, quality gap closure, prior authorization, revenue cycle, and clinical decision support. Every one ships governed, with human approval gates, compliance controls, and audit logging already wired in.
- AI
- Compliance
- HITL · Human in the loop
Appointment Confirmation & Rescheduling Agent
Confirms upcoming appointments, handles reschedule requests conversationally, and finds the next compliant slot—routing every calendar change through a staff approval gate.
Continuous Financial Performance Monitoring Agent
Ingests claims run-out, projects year-end shared savings or losses, identifies cost drivers, models interventions, and tracks ACO REACH risk corridor position.
Continuous Population Risk Scoring Agent
Aggregates multi-source patient data, segments members into risk tiers, detects tier transitions, and generates care management worklists with explainable risk drivers.
Gap Identification & Prioritization Agent
Reconciles payer gap lists against clinical data, scans records for already-closed gaps, calculates HEDIS compliance, and prioritizes open gaps by clinical and financial impact.
Intelligent Referral Routing Agent
Detects referral orders, matches patients to optimal in-network specialists, checks prior auth, transmits referrals, tracks completion, and flags network leakage.
Pre-Appointment Chart Review Agent
Synthesizes each scheduled patient's chart into a one-page visit prep brief covering problem list, gaps, HCCs, meds, and items the physician should address today.
Pre-Submission Claims Intelligence Agent
Validates claim completeness, scores denial probability, flags high-risk claims with remediation recommendations, and submits clean claims to the clearinghouse.
Prior Authorization Automation Agent
Analyzes incoming PA requests against NCD/LCD criteria, verifies provider credentials, and generates authorization decisions with full audit documentation under payer oversight.
Prospective HCC Chart Review Agent
Scans patient charts before scheduled visits to surface suspected HCCs with MEAT evidence, generating physician-facing pre-visit briefs under CMS V28.
SDOH Identification & Action Agent
Identifies social determinants from clinical notes and screenings, maps findings to Z-codes, matches needs to community resources, initiates referrals, and tracks outcomes.
Sertraline Clinical Decision Agent
Walks providers through a structured sertraline safety assessment—Black Box monitoring for paediatric patients, serotonin syndrome screening, drug interaction checks, GAD-7 disease control, and PharmD escalation on hard stops.
Attribution Monitoring & Optimization Agent
Replicates CMS attribution algorithms (MSSP, REACH, MA), predicts attribution changes, quantifies financial impact, and drives retention outreach to keep the right patients attributed.
Chronic Disease Management Outreach Agent
Identifies high-risk chronic disease patients, personalizes outreach campaigns, executes multi-touch voice/SMS sequences, and triages patient responses to close HEDIS/Stars gaps.
Contract Scenario Planning Agent
Models new VBC contract opportunities with financial projections, sensitivity analysis, and risk assessments, producing executive decision packages—all recommendations require human approval.
Gap Closure Execution Agent
Runs multi-channel patient outreach, triggers in-visit gap alerts, generates bulk standing orders with physician sign-off, tracks closure, and submits to payers.
Post-Denial Management Agent
Classifies denial root causes, assesses appeal merit with human oversight, generates appeal packages, tracks resolution, and feeds outcomes back to prevent future denials.
Readmission Risk Prediction Agent
Scores 30-day readmission risk at discharge, triggers tiered post-discharge outreach, monitors recovery signals, and escalates deteriorating patients to clinical teams.
Real-Time Encounter Documentation Agent
Ambient-listens to the patient–clinician conversation, drafts a structured SOAP note, surfaces HCC and care gap opportunities live, and routes to the physician for sign-off and EHR write-back.
Retrospective Chart Audit Agent
Retroactively mines closed charts for missed HCCs, prioritizes by financial impact, pre-validates against denial patterns, and batches for coder review and submission.
Warfarin Clinical Decision Agent
Walks providers through a structured warfarin assessment—bleeding versus thromboembolic risk balance, INR therapeutic-range adherence, drug-food interaction screening, dose-adjustment guidance, and PharmD escalation on hard stops.
GLP-1 Agonist Clinical Decision Agent
Walks providers through a structured GLP-1 receptor agonist assessment—MTC and MEN2 contraindication screening, GI tolerability and titration pacing, pancreatitis surveillance, glycaemic and weight trajectory monitoring, with PharmD escalation on hard stops.
Medication Refill & Pricing Agent
Helps members find the most affordable medication refills by comparing pharmacy pricing, calculating insurance cost-share, and generating interactive pricing guidance in the member's preferred language.
Clozapine Clinical Decision Agent
Enforces Clozapine REMS programme compliance—mandatory ANC monitoring gates, agranulocytosis and myocarditis screening, metabolic and seizure threshold surveillance, bowel obstruction prevention, with PharmD escalation on hard stops.
Case study
ThoroughCare turned faster enrollment into revenue
and more time to focus on patients.
ThoroughCare earns revenue per enrollment. A six-month enrollment cycle set a hard ceiling on growth, and rigid legacy automation turned every attempt to speed it up into a new source of risk. actAVA rebuilt enrollment as governed agent work. Agents prioritize patients by clinical risk and reach each one on the channel they answer. Care teams keep working from data they already trust. Every attempt stays on the record, and humans still decide the calls that matter. Enrollment became a growth lever instead of a constraint.
- 83%
- shorter enrollment cycle
- 5x
- enrollments per care manager
- 11x
- less token burn
“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.”
90-day value realization
Start quickly.
- Plan your agent roadmap and the digital workforce budget behind it.
- Build agents right away, accelerated by an actAVA team beside yours.
- Integrate your systems of record and launch from our prebuilt agent library.
Run safely.
- Establish the AI policies, frameworks, and evaluation rubrics you need.
- Evaluate how every agent performs, then inspect and improve behavior.
- Govern every agent and orchestrate them across all of your systems.
Grow intelligently.
- Control model costs with real-time consumption monitoring in view.
- Distribute agent resources across functions and shifting business demand.
- Measure business impact on an ROI dashboard you configure yourself.
Care management agents you can govern, prove, and own.
Build agents on a platform that tests them before they go live, keeps every action on the record, and puts the intelligence behind them under your control.