Elythea

AI Call Center for Scalable Managed Care Member Outreach

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Description

Elythea provides an advanced AI contact center solution specifically designed for Managed Care Organizations (MCOs) managing Medicaid and Medicare members. Utilizing highly realistic voice AI and automated SMS messaging, the platform replaces traditional call centers, enabling scalable outreach to thousands of members within minutes. Elythea aims to engage members effectively, close quality care gaps impacting HEDIS, CAHPS, and STARS ratings, and streamline various operational tasks.

The service operates on a low-lift partnership model, requiring only a member list from the MCO without needing deep system integrations. It can be whitelabelled under the health plan's brand to maintain member trust. Key functions include conducting Health Risk Assessments (HRAs), managing pharmacy outbound communications like prescription reminders, automating welcome calls for new members, scheduling high-risk patients with care managers, and verifying provider directory information efficiently.

Key Features

Human-Like Voice AI: Engages members with natural-sounding automated voice calls.
AI-Driven SMS Engagement: Reaches members through automated text messaging campaigns.
Scalable Outreach Platform: Contacts thousands of members in minutes, replacing manual call centers.
Whitelabelled Service: Operates under the health plan's branding for seamless member experience.
Low-Lift Integration: Requires only a member list, with no deep technical integration needed.
Automated Health Assessments: Conducts HRAs, SDoH, and other required screenings at scale.
Care Gap Closure: Sends reminders for screenings (e.g., breast cancer, colonoscopies) to improve quality scores.
Pharmacy Communication Management: Handles prescription reminders, missed pickup notifications, and pharmacist transfers.
Provider Directory Verification: Automates monthly verification of provider information.

Use Cases

Automating member outreach for large Managed Care Organizations.
Improving HEDIS, CAHPS, and STARS quality scores by closing care gaps.
Conducting Health Risk Assessments and SDoH screenings efficiently.
Streamlining pharmacy communications and adherence programs.
Scheduling high-risk members for care management appointments.
Maintaining accurate provider directories through automated verification.
Delivering mandatory welcome calls to new health plan members cost-effectively.

Frequently Asked Questions

How do you contract with Managed Care? What is the lift?

We are one of the lowest-lift vendors. We have no deep integration and no separate platform. We only require your member list. From there, we automatically reach out to members for our contracted purpose -- whether it's conducting an HRA or scheduling members with a care manager appointment.