M18 · CGAE
Care Gap Auto-Engagement
Detect open quality and care-management gaps and route them through VIDA voice, SMS, portal, and care-coord call queues — automatically, with full audit trail.
Engine · live · last 24h
2,418 gaps
open across 1,847 patients · 12 active rules · 3 paused
Outreach sent (24h)
1,284
▲ 18% vs avg
Patient response
61%
784 of 1,284
Gaps closed (24h)
217
▲ 12 vs avg
Engine running
v3.4.1 · last cycle 47s ago
next sweep in 3m 18s
Active rules 12
Live activity 217
Paused 3
Drafts 2
Outcomes
Window · Last 24 hours
Active rules 12 · sorted by gaps closed (24h)
Sort: closures ↓
A1c overdue · DM2 panel
IF dx = DM2 AND days_since_a1c > 90 THEN reach
CBP·CDC
VIDA voice
SMS fallback
CC call · day 7
62
closed · 24h
On
PHQ-9 due · BHI cohort
IF in_bhi AND days_since_phq9 > 28 THEN reach
DEP·BHI
VIDA voice
Portal
38
closed · 24h
On
SUPD adherence · statin
IF rx = statin AND mpr < 0.8 THEN reach
SUPD
SMS
Mail · day 14
31
closed · 24h
On
CBP not at goal · HTN
IF dx = HTN AND last_bp_sys > 140 THEN reach
CBP
VIDA voice
CC call
28
closed · 24h
On
AWV due · Medicare
IF medicare AND days_since_awv > 365 THEN reach
AWV
Portal
SMS
22
closed · 24h
On
Cologuard / FIT due · CRC
IF age 45–75 AND days_since_crc > 730 THEN reach
COL
Mail kit
Portal
14
closed · 24h
On
Falls risk · STEADI screen
IF age > 65 AND days_since_steadi > 365 THEN reach
FALL
VIDA voice
12
closed · 24h
On
RPM transmission lag
IF rpm_active AND days_no_data > 5 THEN reach
99454
VIDA voice
CC call · day 2
10
closed · 24h
Paused
Showing 8 of 12 · Show all
Live activity last 60 minutes · auto-refresh
Filter: All channels
10:42:18
2s ago
✓
Marquez, Jose · A1c gap closed via VIDA voice · 3:42 talk · MRN 4419873
A1c
10:42:04
16s ago
⌖
Tran, Diana · VIDA outreach started · PHQ-9 due · MRN 5102201
PHQ-9
10:41:47
33s ago
✉
Patel, Saanvi · SMS sent · CBP not at goal · last BP 158/92 · MRN 6018440
CBP
10:41:21
59s ago
✓
Brown, Robert · CRC kit ordered via portal · MRN 4892011
COL
10:40:55
1m ago
!
Hall, Linda · 3rd attempt failed · escalating to CC call queue · MRN 2284108
SUPD
10:40:32
1m ago
⌖
Nguyen, Edward · VIDA outreach scheduled · STEADI fall screen · tomorrow 10:00 · MRN 3741002
FALL
10:39:48
2m ago
✓
Kowalski, James · GAD-7 captured via portal · score 9 · MRN 5594031
GAD-7
10:39:11
3m ago
✉
Cohort: AWV-overdue · 47 SMS sent in batch · template AWV-2026-Q2
AWV
Outreach outcomes · last 30 days
Per rule ↓
Gaps detected
100%
Outreach sent
88%
Patient response
55%
Action taken
39%
Gap closed
24%
Escalated to CC
14%
24% gap-closure rate · ~1.6 CC minutes saved per closed gap · est $184k Stars + measures revenue lift YTD attributable to CGAE.
Channel performance · 30d
| Channel | Sent | Resp. | Closed |
|---|---|---|---|
| VIDA voice | 3,418 | 82% | 31% |
| SMS | 4,201 | 48% | 22% |
| Portal msg | 2,108 | 54% | 28% |
| CC call | 982 | 76% | 38% |
| 595 | 21% | 14% |
VIDA voice remains the highest-yield channel by response and second-highest by closure. CC call closes best but is rate-limited by staff capacity.