In short
Consig helps health plans automate member outreach that supports HEDIS and Star Ratings, closes care gaps, reduces readmissions and improves medication adherence. Calls display with branded caller ID, members are authenticated, routine steps are automated, and members who need a nurse or care manager are handed off with context. A compliance engine enforces federal and state rules on each call.
- 75%
- Of high-risk members a dedicated nurse follow-up team never reachedSource: GuideWell clinical leaders, as cited in RJ Burnham's Plug and Play Orlando talk
- $16,300
- Average cost of a 30-day all-cause adult readmissionSource: AHRQ HCUP Statistical Brief #304
- $1.86M
- OptumRx settlement over clinical-adherence calls placed to wrong numbersSource: Patterson v. OptumRx, Mar 2026
Which health plan measures depend on outreach?
More than most teams track. Preventive care and closed care gaps lift the measures that drive reimbursement, including HEDIS and Star Ratings. Post-discharge contact feeds Star Ratings and shared-savings performance, and post-discharge outreach lowers readmission rates, with each avoided readmission worth roughly $15,000. Outreach calls have also been shown to improve medication adherence.
Every one of those depends on actually reaching the member. The Slam-Dunk Case for Post-Discharge Phone Calls breaks down the four ways the money moves.
Why do high-risk members go unreached?
Not for lack of effort. Clinical leaders at GuideWell described a dedicated nurse team whose only job is following up with high-risk members, and 75% of those members were never reached, because nurses spend their days calling, not connecting. Today a nurse may reach 15 members in a day; with the right automation, Consig believes that number can reach 30 or more.
Consig's agent runs the first part of the workflow: the initial outreach, checking whether it is a good time, verifying identity, administrative steps and basic data collection. Nurses take over for the clinical conversation. Consig already powers over a million follow-up conversations a year for claim processes with a partner. See Consig AI takes the stage at Plug and Play Orlando.
How do plans call at scale without adding compliance risk?
Well-intentioned outreach is not exempt. OptumRx settled over medication-adherence calls that reached wrong numbers, and since February 2024 the FCC treats an AI-generated voice as an "artificial or prerecorded" voice. A single member call can implicate TCPA, HIPAA, Medicare contact rules, Do Not Call and state law at once.
Consig's compliance engine governs every call so your team does not have to, and steps with legal weight run as deterministic stages. Identity is confirmed through passkeys, device biometrics or one-time passcodes before health information is discussed, so the right member hears the right message.
- "In healthcare, every patient conversation is a potential compliance event... With hundreds of conflicting communication laws across states, it is essential to have a system that monitors and enforces compliance." Rufus Howe, MN, FNP, Consig advisory board
Will members trust a call from their plan?
Members are wary of calls, and carriers aggressively flag business calls. Consig handles caller ID and number reputation through carrier relationships so plan calls display as your organization, and verification replaces the date-of-birth questions that anyone can answer. Trust has to run in both directions, as covered in Trust on the Line.
Frequently asked questions
How can automated calls help with HEDIS and Star Ratings?
Many measures depend on members taking an action, such as completing preventive care, closing a care gap or following up after discharge, and each starts with a conversation. Consig lets plans run far more of those conversations without adding headcount, getting calls answered, authenticating members and handing them to staff or scheduling the next step.
Can Consig hand members off to our nurse care managers?
Yes. Consig integrates with major call center and UC systems, so a member who needs clinical attention is transferred with call-attached data, or the follow-up is scheduled for later. Consig handles the work that requires no clinical judgment, so care managers spend their time on the members who need them.
Are medication adherence calls risky under the TCPA?
They can be. OptumRx settled for about $1.86 million over clinical-adherence calls placed to wrong numbers, a consent and data-hygiene gap rather than bad intent. Consig's compliance engine enforces the relevant federal and state rules on each call, and identity verification confirms the right member answered before health information is discussed.
Does Consig run at health-plan scale?
Consig runs roughly 2 million patient calls a year in production, including over a million follow-up conversations a year for claim processes with a partner. One early customer that needed to reach over a million patients a year automated 80% of its outreach and saved $700,000 annually.
Does Consig help with post-discharge readmission programs?
Yes. Post-discharge follow-up is one of Consig's core workflows. Calls run a structured check-in on medications, warning signs and follow-up visits, and escalate to nurses when an answer needs clinical judgment. The Care Transition demo on the Consig solutions page lets you hear an example call.