Live Agent Demo

End-to-End Care Gap Closure

Watch an agentic AI autonomously identify open care gaps, prioritize high-risk members, draft personalized outreach, and log every intervention — end to end.

Agentic AI Medicare Advantage Simulated
Member Cohort Loaded
Scanning
Plan SilverCare MA (HMO)
Cohort Stars Quality Improvement
Measurement Year 2025 HEDIS
Members Loaded 12 (sample cohort)
agent > load_cohort(plan="SilverCare-MA", year=2025, measure_set=["CDC","CBP","COA","AWV","BMI"])
Member ID Name Age Conditions Last Seen HEDIS Gaps
MA-00142 D. Rivera 71 T2DM, HTN 14 months ago HbA1c CBP AWV
MA-00287 E. Thornton 68 T2DM, CKD-3 8 months ago HbA1c eGFR BMI ✓
MA-00391 M. Okafor 74 HTN 7 months ago CBP AWV ✓
MA-00455 R. Castellanos 66 T2DM 3 months ago HbA1c CBP ✓ BMI ✓
MA-00512 F. Nguyen 79 HTN, CAD 9 months ago CBP AWV Statin ✓
MA-00618 A. Patel 72 T2DM, Obesity 2 months ago HbA1c ✓ BMI counsel
MA-00703 L. Washington 67 HTN, Afib 6 months ago CBP Anticoag ✓
MA-00841 J. Kim 75 T2DM, HTN 11 months ago HbA1c CBP
MA-00922 B. Adeyemi 70 HTN 1 month ago CBP ✓ AWV ✓
MA-01004 C. Mueller 69 T2DM 5 months ago HbA1c BMI ✓
MA-01107 S. Russo 73 HTN, T2DM, CKD-2 7 months ago HbA1c eGFR CBP
MA-01238 T. Brennan 65 None on file 4 months ago AWV
Agent scanned 12 members — found 23 open HEDIS gaps across 5 measure sets. Proceeding to gap analysis…
HEDIS Gap Analysis
AI Reasoning
agent > analyze_gaps(cohort, measures=["CDC","CBP","COA","AWV"], cross_ref=["claims","EMR","pharmacy"])
Total Open Gaps 23
Critical (3+ gaps) 3 members
High (1–2 gaps) 7 members
Closed / Compliant 2 members
HEDIS Measure Description Open Gaps Stars Impact Closable This Cycle
CDC–HbA1c Diabetes: HbA1c testing <8% 7 ★★★★☆ 7 / 7
CBP Controlling High Blood Pressure 6 ★★★★★ 5 / 6
COA–eGFR CKD: annual kidney function test 3 ★★★★☆ 3 / 3
AWV Annual Wellness Visit 4 ★★★☆☆ 2 / 4
BMI–Counsel BMI & weight management counseling 2 ★★☆☆☆ 2 / 2
Total / Estimated Closable 23 19 / 23 (83%)
AI identified CBP as highest-impact measure for Stars improvement. Routing 3 critical-risk members to priority queue. Generating risk scores…
Risk Stratification & Prioritization
ML Scoring
agent > risk_score(members, model="composite-v3", factors=["gap_count","acuity","tenure","engagement_history"])

The agent applied a composite risk model weighing clinical acuity, number of open gaps, months since last engagement, and historical non-response. The three members below are prioritized for immediate outreach.

D. Rivera
MA-00142
94
Critical
HbA1c CBP AWV

14 months since last visit. Uncontrolled T2DM + HTN. 3 open gaps.

S. Russo
MA-01107
88
High
HbA1c eGFR CBP

Triple comorbidity. CKD-2 progression risk. All 3 gaps open 7+ months.

E. Thornton
MA-00287
79
High
HbA1c eGFR

CKD-3 + T2DM combo requiring urgent kidney monitoring. 8 months lapsed.

Top 3 members selected. Generating personalized multi-channel outreach — letter + SMS — for each member…
AI-Generated Member Outreach
GenAI Draft
agent > draft_outreach(member="MA-00142", channels=["letter","sms"], tone="warm_clinical", language="en", gaps=["HbA1c","CBP","AWV"])

The agent drafted personalized outreach for D. Rivera (MA-00142), referencing their specific open gaps and care context. Select a channel to preview:

March 18, 2025  |  Member ID: MA-00142
Dear Mr. Rivera,

We're reaching out because we care about your health — and our records show there are a few important health checks we haven't been able to confirm for you this year.

As a valued SilverCare Medicare Advantage member managing Type 2 Diabetes and high blood pressure, staying on top of routine screenings can make a real difference in your long-term wellbeing.

Based on your care history, we'd like to help you schedule:

  • HbA1c blood test — Checks your average blood sugar over the past 3 months
  • Blood pressure check — A quick reading to ensure your pressure is within a healthy range
  • Annual Wellness Visit — A covered benefit that helps us build a personalized prevention plan for you

These services are fully covered under your plan at no cost to you. To schedule, simply call us at 1-800-555-0142 or visit any in-network provider. Our Care Coordinator, Angela, can also help — reply to this letter or call her directly.

Warm regards,
Angela Torres, RN
Care Coordination Team, SilverCare Medicare Advantage
This letter was prepared with AI-assisted drafting and reviewed by a licensed care coordinator. All member data is handled in accordance with HIPAA.

Simulated SMS exchange — SilverCare Care Line → D. Rivera

Today, 10:14 AM
Hi Mr. Rivera, this is SilverCare MA. You have 3 care checks due this year (HbA1c, BP, Annual Visit) — all free with your plan. Reply YES to have a coordinator reach you, or call 1-800-555-0142. Reply STOP to opt out.
10:31 AM
YES please
10:31 AM
Great! Angela from Care Coordination will call you within 2 business hours at your number on file. She'll help schedule all 3 appointments at a time that works for you. Thank you, Mr. Rivera! 🌟
MyPlan Portal · Secure Message
From: SilverCare Care Team March 18, 2025
Subject: Action needed: 3 care gaps open for 2025

Hello Mr. Rivera,

Your personalized health checklist for 2025 shows 3 outstanding care items that may impact your health and Star plan rating. We've identified these based on your current conditions and plan history:

⚠ Open Care Gaps — 2025

  1. HbA1c Testing — Last completed: >12 months ago
  2. Blood Pressure Control (CBP) — No reading on file for 2025
  3. Annual Wellness Visit — Not yet scheduled

→ Schedule all 3 now via your portal

SilverCare Care Coordination  |  HIPAA Secure Message
Intervention Audit Trail
Logged
agent > log_interventions(batch_id="CGC-2025-0318", members=["MA-00142","MA-01107","MA-00287"], auto_commit=True)

Every agent action is immutably logged with timestamps, channel, content reference, and compliance flags — ready for Stars audit or care manager review.

Outreach Sent — D. Rivera (MA-00142)
Letter + SMS dispatched. 3 gaps flagged: HbA1c, CBP, AWV. Channel: USPS + SMS. Consent: opt-in on file. Draft reviewed by Angela Torres, RN.
10:14 AM
SMS Response Received — D. Rivera (MA-00142)
Member replied "YES" at 10:31 AM. Care coordinator follow-up scheduled within 2 business hours. Status updated: Engagement → Warm.
10:31 AM
Outreach Sent — S. Russo (MA-01107)
Letter + portal message sent. 3 gaps: HbA1c, eGFR, CBP. No SMS consent on file — skipped. Logged per TCPA compliance rules.
10:16 AM
Outreach Sent — E. Thornton (MA-00287)
SMS + letter dispatched. 2 gaps: HbA1c, eGFR. Member preference: English. CKD progression flag added to care manager queue for manual review.
10:18 AM
Batch CGC-2025-0318 Committed to Care Record
All 3 interventions written to member EHR activity log. HEDIS gap closure tracking updated. Next follow-up check: +14 days. Audit hash: 7f3a9c2e.
10:19 AM
Workflow Complete
Done
Care Gap Closure Cycle Complete

The NestedLoop agent autonomously scanned a member cohort, identified 23 gaps, scored risk, drafted personalized multi-channel outreach, and logged every action — all in under 4 minutes.

23 Total Gaps Identified
83% Estimated Closable (this cycle)
3 Priority Members Contacted
<4 min End-to-End Agent Runtime
Capability Demonstrated How NestedLoop Delivers It
Cohort ingestion & gap detection Connects to claims, EMR, and pharmacy data; applies HEDIS logic to flag open measures
ML risk stratification Composite risk model weighing acuity, lapse time, gap count, and engagement history
GenAI outreach drafting Member-specific letters and SMS with warm clinical tone; HIPAA-compliant, human-reviewed
Multi-channel dispatch Letter, SMS, and secure portal — respecting consent preferences and TCPA rules
Immutable audit trail Every agent action timestamped, hashed, and committed to the care record for Stars audit
Human-in-the-loop escalation High-acuity flags routed to care manager queue; agent hands off, doesn't override
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Disclaimer: This is an interactive demonstration using simulated data and pre-scripted AI responses. No real member data is used. All names, IDs, and clinical values are fictional and for illustrative purposes only. Real deployments include full HIPAA compliance, data governance frameworks, and clinical oversight protocols.

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