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We don't just build software. We deliver results. EXPLORE NOW!
See why businesses choose Bonami Software for reliable, scalable solutions. EXPLORE NOW!
We turn ideas into scalable products with proven delivery across 18+ industries. EXPLORE NOW!

The Care Gap Closure Agent: Preventive Outreach at Scale

The agent pulls the eligible cohort, runs outreach, handles replies, and books the visit.

Scope a Care Gap Agent

About the Agent

The agent finds patients due for screening or monitoring, then runs outreach, replies, and booking end to end.

Category

Population Health / Preventive Outreach Agent

Cancer screening, diabetes monitoring, chronic-disease visits, and immunisation catch-up.

  • Screening Gaps
  • Chronic Disease
  • Immunisations
Autonomy Level

Goal-Directed, Not Reactive

Given the objective, the agent runs the whole sequence instead of answering one question and handing off.

  • Multi-Step
  • No Handoff
  • Exception Routing
How It Works

Cohort, Outreach, Response, Booking

Pulls eligible patients from the EHR, personalises the message, reads the reply, and books the slot.

  • EHR Cohort Query
  • Personalised Outreach
  • Response Parsing
  • Autonomous Booking
Integration

FHIR R4, Scheduling APIs, Portal & SMS

Reads the registry over FHIR, writes back to the chart, and reaches patients on the channel they already use.

  • FHIR R4 Endpoints
  • Scheduling API
  • Portal / SMS
  • Chart Write-Back
Why It Works Now

Low Clinical Risk, High Volume

Administrative outreach with acceptable error consequences — the profile agentic AI handles reliably today.

  • Defined Workflow
  • API-Accessible Data
  • Low Error Cost
Build your idea

Talk to our experts

Scope a care gap closure agent against your own registry and payer mix.

  • Free Consultation

The Problem It Solves

Preventive outreach is limited by staff hours, not by clinical need.

Thousands
A care gap registry routinely lists thousands of patients due for screening or monitoring. Working that list by phone is linear work — every call costs staff time, so the list is triaged down to whoever can realistically be reached this month.
One at a Time
Chatbots did not solve this. A chatbot answers a question the patient thinks to ask, then hands off. Nobody initiates outreach, reads the reply, checks eligibility, and books the slot end to end.
Quality Scores
Unclosed gaps show up directly in quality measures and value-based contracts — and later as avoidable late-stage disease.

Outreach across the whole
registry, not just the patients
staff had time to call

Talk to Our Team

How the Agent Works

  • Cohort Identification from the EHR

    Cohort Identification from the EHR

    Cohort Identification from the EHR

    • Queries FHIR R4 for patients due against each measure
    • Applies exclusions: completions, opt-outs, contraindications
    • Refreshes the cohort continuously, not monthly
  • Personalised Multi-Channel Outreach

    Personalised Multi-Channel Outreach

    Personalised Multi-Channel Outreach

    • Writes outreach to the gap, history, and language
    • Sends by portal or SMS, then follows up on cadence
    • Covers the whole cohort at once, not staff order
  • Response Handling & Booking

    Response Handling & Booking

    Response Handling & Booking

    • Reads free-text replies, deferrals, and constraints
    • Checks coverage and books through the scheduling API
    • Writes outreach, response, and booking to the chart
  • Exception Routing to Staff

    Exception Routing to Staff

    Exception Routing to Staff

    • Escalates clinical questions and symptoms to staff
    • Flags anything outside the validated scenarios
    • A review queue for cases needing human judgment
  • Measure Performance Reporting

    Measure Performance Reporting

    Measure Performance Reporting

    • Tracks closure rate per measure, cohort, and outreach channel
    • Separates gaps closed by the agent from those closed in clinic
    • Feeds quality reporting without a manual chart pull

What It Takes to Deploy

Hover a row to see what changed.

Why Build It With Bonami

We work in EHR APIs, FHIR, and HIPAA infrastructure daily, and design the agent-clinician boundary first.

What Deployments Report

Every number below was measured in production after launch — not projected in a pitch deck.

Thousands

Patients Reached Per Cycle — Outreach no longer capped by staff hours

4 Gaps

Measure Types Covered — Screening, diabetes, chronic, immunisation

End-to-End

Outreach to Booked Appointment — No coordinator handoff on routine cases

2026

Live in Health Systems Today — A leading agentic use case, not a pilot

Global presence

Three offices. One team.

Hi, I'm ARIA. Ask me anything about Bonami's AI agents.