Clinical insight to completed care.
Specialized AI agents help practice managers find members at risk, act on closable care gaps and keep care moving. Every agent works from the same member context.
We use voice, async texting and portal messages to communicate with the member.
Engaged members drive better outcomes and lower spend.
We want care managers to focus on care, and let Actera do the manual work.
Voice AI is only one part. We learn your workflows and automate the important work that takes the most time.
Unify. Decide. Act.
From raw plan data to completed actions, in one loop.
We need claims, pharmacy, eligibility and network data to begin with.
You can use your own risk scoring algorithm or use ours.
- HCCs and HEDIS measures tell our system which conditions or care quality measures need to be assessed or documented this year.
- For each clinical area, clinical urgency, expected benefit and how overdue a measure is set the next best action.
- CCI and RAF set how much support a member needs. Higher CCI means more touch points.
- Members with the same actions and goals are grouped into a campaign and launched together.
- As members respond or new data arrives, each record updates to show how the campaign performed.
We know which plans missed their Star Rating, and which gaps caused it.
We help them close those gaps so they can achieve higher Star Ratings.
We’re starting with the AWV. Next, we’re building an automated playbook for every MA measure, so every care gap closes efficiently.
One visit that captures screenings, assessments and lab orders.
Survey measures fail when members forget the visit. Post-visit follow-up helps them remember the care they got.
The AWV writes the orders. These follow each one through: lab draws, FIT kit returns, retinal exams, DEXA after fracture and BP rechecks.
Adherence measures count triple. We watch pharmacy claims daily, catch late refills, remove barriers and confirm every fill.
One feed powers four measures: admit and discharge events trigger the 48-hour call, the 7-day visit and medication reconciliation.
One number members call or text to get booked anywhere, plus plain-language visit summaries.
Annual Wellness Visit gap closure.
The AWV is the highest-impact intervention in Medicare Advantage. It touches risk adjustment revenue, HEDIS compliance and Star Ratings at once.
Actera finds every member missing their AWV, handles outreach and scheduling, confirms completion and makes sure new diagnoses are captured for HCC coding.
ROI figures are illustrative estimates for a hypothetical 500K-member plan. Actual results depend on population, contracts, data completeness, program design, and execution.
Get members into the programs you already pay for.
We reduce the total cost of care by navigating members to underutilized, low-cost in-network options and to providers that are high quality and low cost.