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For ACOs, Medicare Advantage & value-based care

AI check-in calls that catch high-risk decline between visits.

Family Guardian AI calls your highest-risk Medicare patients between visits, listens for the warning signs that lead to hospital stays, and gets the urgent ones to a clinician in real time — while drafting the CCM documentation your team bills.

  • HIPAA-compliant
  • BAA-ready
  • CPT 99490-native
  • Transparent AI
Monday · June 16

Good afternoon, Dr. Patel

Here's what your panel looks like right now.

Red
3
Need review
Yellow
11
Need review
Green
18
Good news
Active
412
In your panel
Calls today
38
of 44 scheduled
CCM this month14 notes ready to bill
Billing
Today's care queue AI prioritized
James Foster76yCHFCKD2 open flags

Short of breath climbing stairs this week, and up about three pounds since the last call. Took his water pill this morning.

Review nowCalled this morning
Rosa Delgado68yT2DMHTN1 new · 2 open

Morning glucose running a little high the last few days. Mentioned she ran out of one of her medications and hasn't refilled yet.

Review todayCalled yesterday
Eleanor Shaw81yCOPDall reviewed

Breathing easier than last week and picked up her refill on time. Good spirits, walking each morning.

Logged — no actionCalled yesterday
What the AI didLast 24h
  • 73 AI calls placed — 61 completed, 9 no answer
  • 14 CCM notes ready to bill
  • 5 new concerns — 3 red, 2 yellow · 18 positive signals
Illustrative · sample data
Hear the voice

A sample of our AI voice. Illustrative — not a recording of a real patient call.

The problem

High-risk patients don't decline in the clinic.

They decline at home, between appointments, when no one is watching closely enough. Symptoms creep up, a medication gets missed, a small issue becomes an expensive one. Care teams know early contact matters — they just can't call everyone.

  1. 01Day 9 — skips a dose, feels fine
  2. 02Day 23 — weight creeping up, ankles swelling
  3. 03Day 38 — new shortness of breath at night
  4. 04Day 52 — emergency department admission

Every one of these was a chance to intervene — and a phone call could have caught it.

The platform

Four jobs, one connected system.

Voice in, risk out, the right concern in front of the right clinician — and the documentation to show for it.

Voice check-in calls

A calm, natural call your patients actually pick up — on their own schedule, in plain conversation.

Risk detection & escalation

It listens for the signs that lead to hospital stays and gets the urgent ones to a clinician in real time.

Care-team console

One queue that ranks the few patients who need attention today — with the context to act on each.

CCM documentation

Every call is structured into the documentation Medicare asks for under CPT 99490. You bill; we document.

Clinicians stay in control

Your clinical team holds the keys.

No workflow runs with real patients until a supervising physician signs it off — enforced in the database. It extends the reach of your care team — it never replaces a clinician, diagnoses, or prescribes.

  • Physician sign-off gateNo workflow reaches a patient until a supervising physician signs it off.
  • Real-time escalationUrgent signs page a clinician right away; the rest is logged and trended.
  • HIPAA-compliant, BAA-readyEncrypted in transit and at rest; a BAA before any real patient data flows.

See it run on your panel. In twenty minutes.

A working walkthrough on your patient mix and your geography — the real product, not slides. We'll show the calls, the escalation path, and the CCM documentation your team would bill.

A real person replies — usually the same business day. No sales sequence, no obligation.