March 28, 2026
The average care manager handles 150-300 patients but spends 60% of their time on administrative tasks: making outreach calls, scheduling appointments, documenting interactions, tracking referrals, and chasing down information across systems. That leaves less than 40% of their time for the complex clinical judgment that actually requires human expertise.
Automate: Initial outreach calls, appointment scheduling, medication reminders, barrier screening, transportation coordination, routine follow-up calls, documentation of standard interactions, and referral tracking.
Keep human: Complex clinical assessment, motivational interviewing for behavior change, crisis intervention, care plan design for multi-morbid patients, family/caregiver coordination for complex cases, and clinical escalation decisions.
AI agents automate the 30-day post-discharge TCM workflow: initial contact within 48 hours, medication reconciliation, follow-up appointment scheduling, 7-day and 14-day check-ins, and barrier resolution. Organizations using AI-powered TCM report 85%+ contact rates compared to the 30-40% industry average.
For CCM billing, AI agents conduct monthly check-in calls, monitor symptom changes, track medication adherence, and document the required 20+ minutes of non-face-to-face care coordination time. This enables practices to capture CCM revenue at scale without adding staff.
AI identifies patients with open quality measures (HEDIS, STARS, HCC gaps), prioritizes by impact and likelihood of closure, and conducts automated outreach to schedule the necessary visits, screenings, or assessments.
Start with your highest-volume, most standardized workflow — typically TCM or appointment reminders. Demonstrate ROI in 30-60 days. Then expand to chronic care management, care gap closure, and specialty-specific protocols. The key principle: AI handles the volume so your care managers can handle the complexity.