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.
Agentic AI for care management
Revenue tied to coordinator hours and billable minutes puts a ceiling on growth that hiring can't lift, not against turnover and the physician shortage ahead. This walks through why a general-purpose model doesn't close the gap on longitudinal work that spans systems, and how KORA and CURA make care management agents you can build and test, run on intelligence you own, and defend to an auditor.
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.
The best frontier agent finishes this share of complex care management tasks on the first try.
Its success rate when the same task has to work three runs in a row. Most wins do not hold.
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 studyOwn a model built for the work, not rented by the token.
Care management runs on EHR tool calls, multi-turn clinical dialogue, and months of follow-up. CURA is Actava.ai's trillion-parameter healthcare model, trained through recursive self-improvement and tuned on your plan rules and your members inside your own cloud. Swap it under any KORA agent without rewriting eligibility or risk logic, and own the intelligence instead of leasing it.
Top score on MedAgentBench for EHR tool use, ahead of Claude Opus 4.8, Gemini 3.1 Pro, and GPT-5.5.
First on AgentClinic for multi-turn agentic clinical execution.
Benchmark panels where CURA leads GPT-5.5, Claude Opus 4.8, and Gemini 3.1 Pro.
A 256K context window keeps a full case in view across every touch, and CURA runs behind an OpenAI-compatible endpoint so your team ships without relearning their stack.
Explore CURACare 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 KORAGovern every agent, and prove it to an auditor
KORA writes and versions your AI policies, trains your teams against them, and runs a registry that tests every deployed agent against NIST AI RMF, HIPAA, the CMS Health Equity Initiative, and ONC HT1. Policy sign-offs and red-team evaluations become timestamped evidence, so compliance stays continuous and audit packages generate on demand.
Explore complianceRun 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 CURAOur care management health agent library, yours to extend
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
Refills the calendar after no-shows and reschedule requests, finding the next compliant slot in 90 seconds instead of 12 minutes by hand. Every change routes through a staff approval gate, and same-day no-shows drop 25% to 35%.
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
Routes each referral to the right in-network specialist, verifies payer network and prior auth, then tracks the patient to a completed visit. Network leakage drops 32%, completion climbs from 55% to 80%, and $240K to $900K a year stays in network. Monthly reviews classify the leakage that remains by root cause.
Pre-Appointment Chart Review Agent
Automated chart prep turns each scheduled patient's record into a one-screen brief covering problem list, meds, care gaps, HCCs, and recent labs. Briefs reach the provider's EHR worklist before clinic starts, and same-day add-ons get one within 15 minutes. Each brief saves 12 to 18 minutes per visit.
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
Chronic care engagement runs on multi-touch SMS, voice, and mail sequences, personalized to each high-risk patient the agent identifies. It segments by channel preference, language, and engagement history, then triages responses. Engagement rates run 3x untargeted outreach, 38% of HEDIS and Stars gaps close within 90 days, and manual care manager outreach drops 65%.
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
Closes HEDIS and quality care gaps through multi-channel patient outreach, in-visit gap alerts, and bulk standing orders with physician sign-off. Closure rates run 35% to 50% within 60 days, with 90% of patients touched each month. Closed gaps post straight to the payer quality portal.
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.
From a flagged prescription to a monitored care plan
One safety signal, followed for a week. The Sertraline Clinical Decision Agent from the library above runs the structured assessment, escalates the risk it finds to the pharmacist, gets both prescribers onto one medication list, and stays with the family through Black Box monitoring — every step on the record.
Telehealth sertraline appears on an 11-year-old's medication list
The prescription, both prescribers, and the full medication list stay connected.
- Agent
Starts the structured sertraline safety assessment
- EHRFHIR
Retrieves conditions, medications, allergies, labs, and vitals
- Drug referenceTool
Screens the combination — sertraline with a stimulant is a moderate interaction
- Agent
Flags fragmented care — the telehealth prescriber never saw the methylphenidate
Full run transcript
- Day 1: Telehealth sertraline appears on an 11-year-old's medication list (via EHR). Agent: Starts the structured sertraline safety assessment. EHR via FHIR: Retrieves conditions, medications, allergies, labs, and vitals. Drug reference via Tool: Screens the combination — sertraline with a stimulant is a moderate interaction. Agent: Flags fragmented care — the telehealth prescriber never saw the methylphenidate.
- +2 minutes: Assessment complete with no hard stop (via Agent). Agent: Clears the contraindication gate — no MAOI, no serotonin-syndrome criteria met. Registry via Workflow: Records the paediatric Black Box monitoring requirement. PharmD via Queue: Receives the escalation for medication reconciliation. Agent: "Sertraline 50 mg for off-label paediatric GAD — the telehealth prescriber was unaware of the methylphenidate. Requesting reconciliation before any dose change." PharmD: "Reviewing now. Hold any titration until both prescribers reconcile."
- Day 2: Both prescribers reconcile the medication list (via EHR). Agent: Verifies the reconciliation across both prescriber records. EHR via Workflow: Writes the interaction note and monitoring plan to the chart. PCP via Phone: Confirms the cardiovascular review. Agent: "The cardiovascular review is due before any sertraline dose change." PCP: "Booked alongside his next visit. Keep 50 mg until then."
- Week 1: Black Box monitoring is underway (via SMS). Agent: Runs the weekly suicidality and side-effect screen. Caregiver via SMS: Answers this week's check-in. Agent: "This week's check-in for Ethan — any new or worsening mood changes, agitation, or trouble sleeping?" Caregiver: "No changes. He's actually sleeping a little better this week." Registry via Tool: Logs the GAD-7 trend toward the target of under 8. Outcome via Care plan: Care plan continued — reconciled and monitored.
An illustrative run on a sample patient record from an Actava.ai platform session — every name and value is fictional-tenant data, and the agent's outputs require prescriber and pharmacist sign-off before any clinical action.
Meet the Sertraline Clinical Decision Agent
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.ai 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.
- shorter enrollment cycle
- 83% shorter enrollment cycle
- enrollments per care manager
- 5x enrollments per care manager
- less token burn
- 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.”
Governance you can hand an auditor.
Every agent on this page ships governed. KORA is how you prove it. It writes and versions your AI policies, trains your workforce against them, and runs a registry that tests every deployed agent against the frameworks that decide care management. Policy acknowledgements and evaluations become timestamped evidence, so an audit request turns into a one-click package instead of a scramble.
- Framework coverage
- KORA maps to NIST AI RMF, the HIPAA Privacy and Security Rules, the CMS Health Equity Initiative, ONC HT1, and the state AI laws that keep landing.
- KORA:RED
- Through its KORA:RED integration, KORA red-teams live agents for PHI leakage, hallucination, bias, prompt injection, and scope-boundary breaks, then alerts on model drift before it reaches a member.
Controls mapped across frameworks, always current.
Major frameworks fully supported, NIST, HIPAA, CMS, and ONC.
Continuous agent monitoring with real-time safety guardrails.
Payers use KORA to satisfy CMS Health Equity Initiative mandates for algorithmic fairness in coverage and utilization management, with bias monitoring and disparity documentation built for CMS auditors.
Explore compliance90-day value realization
Start quickly.
Plan your agent roadmap and the digital workforce budget behind it.
Build agents right away, accelerated by an Actava.ai 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 in KORA.
Evaluate how every agent performs, then inspect and improve behavior.
Govern every agent under one policy frame 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 under your control. Orchestrate with KORA, own the model with CURA, and prove every action with the governance built in.