Use Case 1
Daily Risk Refresh
Trigger: Nightly data pipeline completion
1.Ingest claims, ADT, pharmacy, labs, SDOH signals
2.Run risk model with explainable feature importance
3.Assign each member to risk tier
4.Detect tier transitions
5.Generate care manager worklists
6.Alert on tier-1 transitions
✓
Care teams start each day with an updated, explainable risk picture.
Use Case 2
Rising-Risk Intervention
Trigger: Member transitions from low to moderate risk
1.Identify specific risk drivers
2.Match to available intervention programs
3.Assign to appropriate care pathway
4.Schedule outreach
5.Track intervention outcomes
✓
Early intervention on rising-risk members prevents escalation to high-cost events.
Integrations
Claims Data Warehouse
ADT Feed (Hospital Admit/Discharge/Transfer)
Pharmacy Claims
EHR Labs & Vitals
SDOH Data Sources
Care Management Platform
Industries
healthcare
See It In Action
A sample conversation with this agent
Who moved into high-risk this week?
47 members transitioned into the high-risk tier this week. Top drivers: 14 from new ED visits (mostly cardiac and respiratory), 11 from medication non-adherence flags in pharmacy claims, 9 from new specialty referrals indicating disease progression, 8 from lab trend deterioration (A1c, eGFR, BNP), 5 from SDOH signals (housing or food insecurity documented). Full list with drivers and suggested care manager actions is in your worklist.
Why is Robert Nguyen now tier-1 instead of tier-2?
Three signals pushed him up: (1) ED visit last Tuesday for chest pain, negative workup but discharged with new cardiology referral; (2) pharmacy claims show he hasn't filled his atorvastatin in 42 days; (3) his eGFR dropped from 62 to 54 between May and this week's labs. Any single one wouldn't have moved him—the combination crossed the threshold. Model explainability doc is attached to his profile.
Generate tomorrow's care manager worklists.
Generating worklists for your 6 care managers. Workload-balanced and patient-continuity preserved—each CM sees their existing caseload first, with new tier-transitions layered in by priority. Each patient card shows risk tier, drivers, last touch, suggested next action, and preferred contact method. Maria's list has 18 patients with 3 new tier-1 transitions; Sarah's has 22 with 4 new transitions. Ready in your dashboard.