Live Agent Demo

Member 360 Intelligence Agent

Watch an agent synthesize clinical history, SDOH signals, behavioral indicators, and engagement data into a unified member profile — then surface next-best-action recommendations that care managers can act on immediately.

Agentic AI Classical + GenAI Simulated
Domain: Care Management · Member Intelligence
Steps: 6 Runtime: <2 min AI Type: Agentic + GenAI
Member Cohort Loaded
Scanning
Plan SilverCare MA (HMO)
Tier Filter High-Risk Priority
Members 5
Focus Nguyen, T. (MA-00287)
agent > load_member_cohort(plan="SilverCare MA", tier="high-risk", member_focus="MA-00287")
Member ID Name Age Plan Risk Tier Last Engagement Flag
MA-00287 Nguyen, T. 72 SilverCare MA HMO High 47 days ago 3 gaps open
MA-00312 Okafor, B. 68 SilverCare MA HMO Rising 12 days ago 1 gap open
MA-00198 Castillo, E. 79 SilverCare MA HMO High 92 days ago 5 gaps open
MA-00421 Park, S. 65 SilverCare MA HMO Moderate 6 days ago 0 gaps
MA-00156 Washington, D. 74 SilverCare MA HMO High 61 days ago 2 gaps open
5 members loaded
3 High-risk
Avg. days since engagement: 43
Cohort loaded. Initiating multi-source data pull for Nguyen, T. (MA-00287)…
Clinical History Synthesis
Synthesizing
agent > synthesize_clinical(member_id="MA-00287", lookback_months=36, include_labs=true, include_rx=true)
TN
Nguyen, Thi  —  MA-00287
DOB: 1953-04-11  |  Age: 72  |  Gender: F  |  SilverCare MA HMO
Chronic Conditions (5 Active)
Type 2 Diabetes (E11.9) CHF Stage II (I50.22) CKD Stage 3 (N18.3) Hypertension (I10) Peripheral Neuropathy (E11.40)
Recent Utilization (Last 6 Months)
2 ED visits
1 inpatient admission (CHF exacerbation, Feb 2025, 3 days)
14 outpatient visits
Medication List (5 Active)
Metformin 1000mg Furosemide 40mg 18d overdue Lisinopril 10mg Gabapentin 300mg Aspirin 81mg
Key Lab Results
TestResultStatus
HbA1c8.4%HIGH
BMP Creatinine1.8 mg/dLELEVATED
BNP312 pg/mLHIGH
eGFR38 mL/minLOW
2.87
RAF Score
3.14
CMS-HCC Score
36-month clinical history parsed. 5 active chronic conditions. HbA1c 8.4% above target. Furosemide refill overdue 18 days…
SDOH & Behavioral Signal Analysis
Analyzing
agent > analyze_sdoh(member_id="MA-00287", sources=["AHC","claims","pharmacy","call-logs"])
SDOH Assessment — AHC Screening (Jan 2025)
Nguyen, T.  |  MA-00287
Food Insecurity YES — relies on food bank 2×/month
Transportation BARRIER — no personal vehicle, limited transit access
Housing Stable — rents, lives alone
Social Isolation MODERATE — widowed, limited social contact
Utilities Stable
Financial Strain Low — SSI + Medicare supplement
SDOH Risk Score
74/100
HIGH
Behavioral Signals
Missed 3 of last 5 PCP appts
Pharmacy pickup adherence: 61%
CM call answered: 1 of 4 (last 60d)
Preferred contact: Morning Language: Vietnamese
Transportation + food insecurity identified as primary engagement blockers. Vietnamese language preference flagged for bilingual coordinator routing…
Unified Member 360 Profile
Assembling
agent > assemble_360_profile(member_id="MA-00287", components=["clinical","sdoh","gaps","engagement"])
TN
Nguyen, Thi  —  MA-00287
72F  |  RAF: 2.87  |  HCC: 3.14  |  SDOH Risk: 74/100
Priority: 94/100
Clinical Risk
RAF 2.87 · 5 chronic conditions
CHF exacerbation risk: HIGH
Recent inpatient Feb 2025 · BNP trending up
Care Gaps (3 Open)
Diabetic Eye Exam Nephrology Referral Flu Vaccine
SDOH Profile
Transportation + Food Insecurity
Language: Vietnamese
Social isolation: Moderate
Engagement Profile
Response rate: 25%
Best time: 9–11am
Channel: Phone (bilingual)
Overall Priority Score
94/100
Immediate outreach recommended
Unified profile complete. Three open care gaps intersect with SDOH barriers — coordinated intervention recommended…
Next-Best-Action Recommendations
Generating
agent > generate_nba(member_id="MA-00287", constraints=["in-network","sdoh-aware","hedis-weighted"])
1. Schedule Diabetic Eye Exam
High Priority
Rationale: Gap open 11 months. HbA1c 8.4% — retinopathy risk elevated. HEDIS measure: EED (Eye Exam for Patients with Diabetes).
Outreach: Bilingual care coordinator call (Vietnamese). Offer transportation voucher from plan benefit.
Provider: Dr. Lin, Eastside Ophthalmology (in-network, 2.1 mi from member)
Timeline: Outreach within 48 hours
2. Nephrology Referral
High Priority
Rationale: CKD Stage 3 + eGFR 38 + Creatinine trending up — specialist consultation needed to prevent progression.
Recommended: Direct referral to Summit Nephrology. PA not required for this plan.
Timeline: Referral order this week
3. CHF Medication Adherence
Medium
Rationale: Furosemide 18 days overdue — CHF exacerbation risk. Transportation barrier likely contributor to refill gap.
Recommended: Pharmacy home delivery enrollment + adherence reminder call.
Timeline: Same-day pharmacy outreach
3 next-best actions generated. Highest priority: diabetic eye exam — 11 months overdue, HEDIS-impacting. Transport voucher pre-approved via plan benefit…
Care Manager Action Summary
Complete ✓
Member 360 Brief Ready

Complete member intelligence profile with 3 next-best actions generated for care manager review in 1.8 minutes.

Care Manager Brief — MA-00287 Nguyen, T.
Risk Score: 94/100
Open Gaps: 3
SDOH Flags: 2
Priority: IMMEDIATE
Action Checklist
Call bilingual coordinator re: diabetic eye exam + transport voucher
Target: within 48 hours  |  Provider: Dr. Lin, Eastside Ophthalmology
Submit nephrology referral order to Summit Nephrology
Target: today  |  No PA required
Enroll in pharmacy home delivery (Furosemide priority)
Target: today  |  Same-day pharmacy outreach
Estimated Impact
Closing these 3 gaps improves Stars measure performance and reduces 12-month ED readmission risk by ~32%. Member engagement likelihood increases with bilingual outreach + transportation support.
1.8 min Agent generation time
45 min Manual chart review (avg)
View All Demos
Explore More Demos
Agent Demo
Care Gap Closure
Autonomous agent identifies and closes care gaps across a member population using clinical data and outreach automation.
Agent Demo
Prior Authorization
Watch an AI agent review PA requests against InterQual criteria, approve or deny in seconds, and generate peer-to-peer briefs.
Agent Demo
RAF Score Optimization
AI-driven risk adjustment factor analysis identifying documentation gaps and coding opportunities for accurate reimbursement.
Disclaimer: This is an interactive demonstration using simulated data and pre-scripted AI responses. No real patient, member, or provider data is used. All values are fictional and for illustrative purposes only. Real deployments include full HIPAA compliance, SOC 2 audit controls, CMS regulatory adherence, and care management oversight.

Proprietary assets of NestedLoop LLC. Reproduction or re-use with explicit consent and authorization from NestedLoop LLC only.