The Care Management Agent

Care that continues between visits.

It stays with every patient between visits and turns the care you already give into documented, billable work.

Northside Orthopedics · Care Management AgentLive
Between visits
Check-in
Day 12 post-op check-inJohn D. · pain down to 3, walking further
8:40 AM
Survey
KOOS Jr collectedMatched to the pre-surgery baseline
8:44 AM
Flagged
Concerning answer routedSwelling reported · your nurse notified
9:10 AM
Documented
Care log updatedConsent, care plan, and minutes on file
9:11 AM
Reported
Monthly report deliveredAudit-ready summary for your biller
Aug 1
This month
180Check-ins completed
42Outcome surveys collected
6Patients flagged to staff
100%Work documented
See it run

What a month of care looks like, hands-free.

The agent does the outreach and the paperwork. Your team supervises the care.

Checked inA monthly call or text in your practice's name, answered in about ninety seconds.Voice and text
Outcomes collectedValidated surveys like HOOS Jr and KOOS Jr, matched before and after surgery.The measures quality programs score
Concerns flaggedWorrying answers route to your staff. Quiet patients get noticed.Your team decides
DocumentedEvery staff minute logged, consent and care plan on file.Audit ready
BilledYour biller submits through your normal process, from the audit trail.Your normal workflow
What it does

Monthly care, run by the agent, supervised by your team.

Medicare pays for this work. Almost nobody bills it, because the documentation costs more than it returns. Until now.

Voice and text

Monthly check-ins

Checks in with your chronic and surgical patients every month by call or text. Nobody downloads anything.

Validated outcomes

Real outcome measures

HOOS Jr, KOOS Jr, and other validated surveys, matched before and after surgery.

Escalation

Flags who needs attention

Concerning answers route to your staff, who review and act under your physicians' supervision.

Audit ready

Documentation, done

Time logs, consent, care plans, and an audit-ready monthly report for your biller.

Clinekt OS

One platform, one memory.

The Care Management Agent shares a single memory with Inbound, Recall, and Outbound.

Why it matters
The patient who arrived through your website in the spring and answers a check-in this winter is one person to the platform, never a stranger.
Good morning John. Day 12 after your knee replacement: how is the pain today, 1 to 10?
Down to a 3. Walking a little further every day.
Documented · care log
Check-in recorded, recovery on track
Next:Outcome survey, Friday
The agent
Does the outreach, the surveys, and the paperwork
Your team
Supervises the care and handles whoever needs attention
Your biller
Bills from the audit trail, through your normal process
The patient
Feels looked after, and never explains themselves twice
Where CMS is going

Ready for the bundle era.

Medicare's mandatory joint bundles score practices on patient engagement and reported outcomes across the episode of care. The check-ins and surveys the agent already runs are the data those scores are built on.

What does the Care Management Agent actually do?

Every month it checks in with your enrolled patients by call or text, collects how they are doing, gathers validated outcome surveys, and routes anything concerning to your staff. It logs all of it as it happens, so the care your practice delivers between visits is documented without anyone chasing paperwork.

Who does the clinical work?

Your team. The agent does the outreach and the paperwork. Your medical assistant or nurse reviews what it collects and cares for the patients who need attention, under your physicians' supervision. The agent makes those minutes efficient. It never replaces them.

Is the work really billable?

Yes. Medicare has paid practices for monthly care management for years. Most practices never bill it because the outreach and documentation take staff time nobody has. The Care Management Agent produces the consent records, care plans, time logs, and monthly reports your biller needs.

What about surgical patients in the global period?

The platform automatically excludes a surgeon's own post-operative patients from billing during the global period. Their check-ins and outcome surveys still run, and the billing rules respect the bundle.

Does it work with our EHR?

Yes. The Care Management Agent starts from a simple patient list and works alongside Epic, athenahealth, ModMed, NextGen, eClinicalWorks, and the other major systems. No IT project required to begin.

How is this different from survey tools?

Survey tools send forms. The Care Management Agent holds a conversation, remembers the patient's history across every call, text, and email, and connects to the same platform that books new patients and recalls dormant ones.

See the Care Management Agent run a real check-in.

A 15 minute walkthrough: the monthly check-in, the outcome survey, the staff review, and the report your biller receives.