Scalable Population Health Outreach

Target at-risk populations and advance value-based care through personalized outreach addressing chronic disease and illness.

Our scalable outreach solutions target patients throughout the continuum of care so you can:
  • Improve quality of care
  • Achieve HEDIS measures and MACRA compliance
  • Increase preventative care appointments (wellness visits & screenings)
  • Enhance early and periodic screening, diagnostic, and treatment (EPSDT) services
  • Reinforce medication adherence
  • Manage chronic conditions
  • Minimize hours spent in manual outreach

Use Cases

Deliver health information, preventative messaging, and treatment compliance to a variety of targeted populations. Send proactive communications to populations, including:

All Populations:

Encourage patients to schedule annual physicals and vaccinations like flu shots.


At-Risk Populations:

Remind high-risk adults age 55-80 who have used tobacco within the last 15 years to schedule lung cancer screenings.

Colorectal Cancer Screenings:

Encourage at-risk patients to conduct regular screenings for colon cancer. Enable self service ordering for at home test (FIT or FOBT).


Chronic Care:

Promote self-management with patient education reminders when it’s time to monitor blood pressure, blood sugar, and other health monitoring.


Congestive Heart Failure:

Distribute messages offering self-care reminders, patient education on diet, and symptom recognition.

Diabetes Management:

Distribute follow-up communications for diabetic patients reminding them to exercise and eat healthy.


Ensure patients under 21 enrolled in Medicaid receive appropriate preventative, dental, mental health, developmental, and specialty services at periodic intervals through early assessment and screening, diagnostics, and treatment.


Lab Outreach:

Remind patients with incomplete lab procedures to finish lab testing to avoid delay in care.


Deliver perinatal and postpartum messages to women before and after delivery.

Substance Cessation:

Interactive messaging with options to transfer to care team or send help hotline information based on need. Alerts and reminders about upcoming classes and meetings. Patient feedback via SMS on attended classes.

Women’s Care:

Communicate with female populations who are due for preventative OB/GYN care, breast or cervical cancer screenings, and other care at regular intervals.

And more!

Population Outreach Features

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Automated SMS Outreach: We use SMS text to communicate with patients because 98% of text messages are read. Automatically send a text to patients who are overdue for wellness visits or screenings and chronic disease care.

Automated Voice Outreach: For patients who prefer phone calls, we offer automated outbound calling. We’re then able to transfer live calls to your office, so your care team can scale communications to much larger populations more efficiently.

Protocol-Based Messaging: You have complete control over the timing and content of your communications to reinforce patient behavior and adherence to care.

Filtering: Hyper-target your communications by filtering your populations based on care plan adherence, lab value, geographic location, health plan, age, gender, and more.

HIPAA Compliance: We take safeguarding patient information seriously. Our solutions are fully HIPAA compliant.

Multi-Channel Options: We offer text, voice, and email so that you can reach your patients however they want to be reached, whenever you want to reach them.

Two-Way Integration: We seamlessly integrate with any EMR or practice management system for a frictionless connection with your existing workflow