Health Plans — Medicare Advantage & Medicaid

Every member you can’t reach is an open care gap and a Star point at risk.

Linda completes Health Risk Assessments, closes HEDIS care gaps, and screens for social needs — member by member, persistently, in a warm and unhurried conversation — and alerts your care managers to every critical insight, with the full report for context.

HIPAA & SOC 2 compliant · BAA before any data moves · Live in as little as 14 days

Why it matters

HRA completion, gap closure, and member experience all depend on outreach your call centers and care managers can’t scale. Unreached members mean inaccurate risk documentation, open gaps at measurement-year close, and Star Ratings — and their $12.7B in bonus payments — decided by the members nobody talked to.

The economics

A 100K-member MA plan typically unlocks $10–60M a year in risk-adjustment accuracy, gap closure, and Star bonus protection.

Call workflows

Each program spells out the objective, who’s called and when, exactly what Linda covers, the triggers that raise an alert, and what your team gets back.

01

Health Risk Assessment (HRA) Completion

Complete the member’s HRA: accurately capture chronic conditions, functional status, mental health, and social needs (SDOH); confirm the member has a PCP; and alert your staff to clinical or social concerns. Supports risk-adjustment accuracy and surfaces care gaps.

Who / when: New MA members within 90 days of enrollment; existing members annually.

What Linda covers on the call

  • Identity verification, purpose, recording disclosure, and verbal consent
  • Self-rated health and a structured chronic-condition review (diabetes, heart disease, COPD, depression, and more) with management and medication status
  • Medication affordability and adherence screening
  • Recent hospital or ER utilization; PCP relationship and last visit
  • Functional status: ADLs, mobility aids, falls in the past year
  • PHQ-2 depression screening
  • SDOH: food security, transportation, housing stability, social isolation
  • Preventive care status (flu shot, screenings); summary and next-step expectations

When Linda alerts your team

Any expression of self-harm or severe depression; a recent fall with injury; food insecurity or inability to afford medications; uncontrolled symptoms; no PCP; a hospital or ER visit in the last 30 days.

What your team receives

Completed HRAs with structured condition documentation supporting RAF accuracy, flagged care gaps, and same-day urgent alerts to behavioral-health or care-management staff.

02

Care Gap Closure (HEDIS)

Identify overdue HEDIS-measured services (A1c, diabetic eye exam, mammogram, colorectal screening, medication refills, and more), motivate members to schedule, and remove the barriers — transportation, cost, language — that keep gaps open.

Who / when: Members flagged on the plan’s gap list; typically Q2–Q4 campaigns before measurement-year close.

What Linda covers on the call

  • State the specific gap and confirm whether the service was completed elsewhere (capturing provider and date for record retrieval)
  • Explain the benefit is covered at no cost and why it matters
  • Offer scheduling help, including at-home options (e.g., FIT kits) where available
  • Screen for barriers: transportation, cost, interpreter needs, mobility, time-of-day preferences
  • Confirm the next step: appointment made, kit ordered, callback scheduled, or member self-scheduling

When Linda alerts your team

Any active symptom suggesting an urgent problem — a breast lump, blood in stool, chest pain, vision loss — triggers an urgent alert so your clinical team can arrange a diagnostic (not routine screening) pathway.

What your team receives

Gap-closing actions logged per member, barrier data for your SDOH programs, and urgent clinical alerts that would otherwise surface as claims months later.

Also configurable: enrollment welcome calls, medication adherence campaigns, redetermination outreach (Medicaid), and post-discharge transition-of-care calls — built on the same program framework.

What your team gets

Linda does the dialing; your people get the signal. Every program feeds the same four outputs.

Reports and alerts from every interaction

Every call becomes a clear report, and alerts flag the interactions that need staff follow-up — delivered instantly by SMS and email.

A complete profile for every patient or member

Their data (via CSV or API), full history of activity with Linda, every alert and report — plus a place for your staff to add notes.

A real-time dashboard with high-level KPIs

See Linda’s activity across your entire patient or member pool at a glance, and track the numbers that matter.

Full visibility into every program

View your active call programs, the questions each one covers, and the sequence strategy — number of attempts, time between calls, and calling approach.

The escalation promise

Linda is designed to catch what matters, not to replace clinical judgment. When a call surfaces a critical insight — a concerning symptom, a safety risk, a medication question, signs of crisis — your staff get an instant SMS and email alert so they can handle next steps, with the full call report available for context. On these calls, the alert is the success.

Every call program is reviewed and approved by your clinical and compliance teams before launch, and tailored to your protocols and populations.

See what Linda can do for your organization.