Member Action Platform · Healthcare
Healthcare Has a Completion Problem.
You know who needs care. The gap is making sure they actually get it.
Health plans have invested billions in analytics, care management, and outreach — and they know more about their members than ever before. The bottleneck was never identification. It's activation. Capillary's Member Action Platform closes the distance between identified opportunity and completed care — at scale, across every member, every channel, every market.
4 gaps
Where value leaks
between insight and
completed action
↑ RAF
More complete risk
adjustment capture
↓ Cost
Reduced avoidable
utilization
The Hidden Value Leakage Gap
Value is lost at every step between identifying need and completing care.
Healthcare actions are rarely one step. A mammogram is not simply a mammogram — it requires understanding, provider selection, scheduling, transportation, follow-up, and documentation. Every additional step introduces dropout risk. And friction compounds. Most organizations have addressed identification. Very few have addressed execution.
Identify
Risk / Care Gap /
Need Found
Engage
Outreach
Begins
Friction
Scheduling · Transport
Confusion · Drop-off
Action
Member
Participates
Complete
Care Gap
Closed
Outcomes
Stars · RAF · Adherence
Cost · Retention
Value Leak #1
Limited Relevance or Timing
Generic outreach that ignores member context or timing. Multiple siloed programs — quality, pharmacy, disease management, care — end up competing for member attention.
Value Leak #2
Complexity, Access &
Motivation Barriers
Scheduling friction, transportation gaps, and low health literacy prevent members from taking the first step.
Value Leak #3
Incomplete Action or
Abandonment
Members start but don't finish — appointments not attended, forms incomplete, follow-through not supported.
Value Leak #4
Documentation, Follow-
Through & Provider Gaps
Completed care doesn't get captured — leaving RAF scores understated and Stars measures unclosed.
How the Member Action Platform Closes the Gap
The question is no longer: did we reach the member? It's: did the member complete the healthcare action?
Predictive Intelligence
Identify the right members at the right time
Behavioral Science & Motivation
Increase likelihood of action and follow-through
Navigation & Friction Reductiontion Reduction
Make it easier to act at every step
More Completions. Better Outcomes. Stronger ROI.
Better Quality & Stars
More Complete RAF
Higher Adherence
Higher Adherence
Lower Medical Cost
Stronger Retention
The Member Action Journey
AI-powered guidance across the entire member experience.
Six connected steps that move members from identified opportunity to completed care — and back again, continuously improving with every cycle.
Platform Capabilities
An end-to-end, modular, AI-driven platform built for completed healthcare actions.
Capillary operates as a unified engagement and orchestration platform — or integrates modularly into your existing digital, care management, analytics, and provider ecosystems.
Predictive Intelligence
Identify members most likely to benefit from timely intervention — before care gaps widen, before members disenroll, before costs spike.
RAF + Claims signals
Risk stratification
Disenrollment propensity
Behavioral likelihood modeling
AI Health Buddy
A persistent, conversational health companion that moves members from awareness to action — available across chat, SMS, email, mobile, IVR, and voice.
Appointment scheduling
Provider navigation
Care gap surfacing
Virtual care transfer
Predictive Intelligence
Identify members most likely to benefit from timely intervention — before care gaps widen, before members disenroll, before costs spike.
Next-best-action
Send-time optimization
Milestone journeys
Outreach fatigue reduction
Built for Every Market. Driven by the Same Outcome.
Purpose-built for healthcare's most complex operating environments.
From Medicare Advantage Stars improvement to Medicaid access equity to Commercial cost reduction — one platform, configured for your population and your outcomes goals.
Medicare Advantage
Improve quality, risk capture & member retention
- Stars & HEDIS improvement
- Medication adherence lift
- Annual Wellness Visits
- Complete risk adjustment
- Stronger retention
Medicaid
Improve quality, risk capture & member retention
- Reduce barriers to care — transportation, language, digital access
- SMS, IVR, voice & low-bandwidth digital channels
- Maternal & postpartum care continuity
- Chronic & pediatric care coordination
- Better continuity & reduced avoidable ED visits
Commercial
Improve quality, risk capture & member retention
- Preventive care participation
- Chronic condition management — diabetes, hypertension, behavioral health
- Digital front door: unified navigation, scheduling & benefits
- Personalized next-best-action journeys
- Employee wellbeing & milestone incentives
- Lower avoidable cost growth
Outcomes happen only when action is completed. That's what we make possible.
The Capillary Member Action Platform
Why Capillary
Most platforms optimize for engagement. We optimize for outcomes.
AI-Powered
Orchestration
Intelligent, adaptive outreach that learns what works for each member.
Human
Escalation
Seamless handoff to care teams, nurse lines, and care coordinators when needed.
Secure &
Compliant
HIPAA-ready infrastructure built for the security requirements of health plans.
Open &
Interoperable
End-to-end when needed, modular when preferred. Deploy across medication adherence, RAF capture, preventative care, or navigation — while maintaining interoperability with existing EHRs, care management platforms, and analytics investments.
Outcomes That
Matter
A minimum-plus revenue share model that ties our success to yours.
Healthcare has spent the last decade optimizing for what is measurable. The next decade requires optimizing for what matters.
From activity to completion. From communication to behavior change. From engagement to outcomes.
Get Started
See how Capillary turns care opportunities into completed action.
Request a demo to see the Member Action Platform in the context of your population, your care gaps, and your outcomes goals.
No commitment required · Typically 30 minutes · Tailored to your organization