Every missed call = a missed appointment, a lost referral, or a patient who leaves. Revenue per lost call: $200+.
3 adherence measures are triple-weighted in Part D Star Ratings — thresholds tighten yearly. You're paying $85/call for nurses to hear patients say they take their meds.
Missed calls. Voicemail black holes. Staff burnout. Patients waiting on hold while revenue walks out the door.
Non-adherent members. Manual nurse outreach at $62-85/call. Patients screening your calls. Star ratings slipping.
LexanAI solves both — with a single voice AI platform.
AI answers every call in under 2 seconds. No hold music. No voicemail. 24/7.
Book, reschedule, cancel. Checks provider availability, fills freed slots.
Takes refill requests, verifies identity, routes to pharmacy.
Verifies coverage, checks prior auth, flags out-of-network.
Clinical → nurse. Billing → staff. Routine → AI. Full context on handoff.
No more Monday voicemail pileups. Patients get answers, not recordings.
New patient intake, referrals, demographics — handled before staff gets involved.
Not a glorified answering machine. LexanAI reads and writes directly to your EHR — athenahealth, eCW, Practice Fusion, and more. Appointments actually get booked. Demographics actually get updated.
No "press 1 for scheduling, press 2 for billing." Patients just talk. The AI understands intent, asks clarifying questions, and resolves — like your best front-desk person, but available 24/7.
| Metric | Human Staff | LexanAI |
|---|---|---|
| Cost per call | $8-12 | $0.50 * |
| After hours | Voicemail | 24/7 Live |
| Hold time | 8+ minutes | <2 seconds |
| Calls/hour | 8-10 | Unlimited |
| No-show reduction | — | 35-40% |
$500 platform fee + $1,000 for 2,000 calls
Additional calls at $0.50 each.
Compare: front-desk FTE costs $3,500+/month (salary + benefits + turnover). LexanAI at $1,500/mo = 57% savings.
A care gap is a recommended health action that was never completed — a prescription unfilled, a screening skipped, a follow-up missed.
Doctor prescribes a statin. Patient fills it once, never refills. Open gap — counts against your Star Rating.
Diabetic eye exam overdue 6 months. Patient forgot. Practice didn't follow up. Gap stays open.
Post-discharge follow-up never scheduled. Patient back in the ER. Preventable. Expensive.
3 adherence measures = 30% of Part D Star Rating. The only triple-weighted measures. Drop here, nothing saves you.
CMS clustering algorithm tightens thresholds yearly. 4 stars last year → 3.5 this year. 5★ needs 85-90% at PDC ≥80%.
Patients say they take meds. Pharmacy claims say otherwise. Every self-report program leaks money.
Not just "completed / not completed." Classifies every call: refill confirmed, barrier identified (transportation, cost, side effects), needs escalation, patient unreachable. Real clinical intelligence.
Patient says they're taking their meds? We verify against actual pharmacy claims data. Catches the "lying patient" problem — the #1 reason traditional outreach programs fail.
Proprietary guardrail system. The AI stays on-script, never fabricates medical information, and escalates when uncertain. Zero tolerance for AI errors in healthcare.
Per-practice fine-tuning via our SLM Pipeline. The AI learns your patient population, local pharmacies, and common barriers. More calls = better outcomes.
| Metric | Manual | LexanAI |
|---|---|---|
| Cost per gap closed | $62-85 | $20–30 |
| Annual outreach cost | $150-210K | $50-75K |
| Star Rating boost | +0.5★ | +0.5-1.0★ |
| Bonus revenue impact | $1.2-1.8M/year | |
Now picture both engines on the same AI brain. A patient calls in to reschedule — and also has an open care gap.
Front desk books appointment. Separate team calls weeks later for med adherence. Patient ignores it. Gap stays open. You pay twice.
AI books the appointment, then: "I see your statin is due for a refill — want me to help?" Gap closed in 30 seconds. One call, two problems solved.
One platform, one AI brain — inbound and outbound in a single conversation. No other voice AI does this.
$1,500/mo ($500 platform + $1,000 for 2,000 calls) · 3-month minimum · $20-30/closed gap outbound
Bhuvanesh Ram M
lexan.health