How an AI-Powered Virtual Nurse is Helping Health Plans Scale Care Management 

Key Takeaways

• HealthEdge® partnered with Ellipsis Health to integrate Sage, an AI-powered voice agent, directly into the GuidingCare® platform—giving health plans a scalable way to automate member outreach.
• Sage uses clinically validated conversational AI and an Empathy Engine to conduct emotionally intelligent phone conversations with members across a range of care management programs.
• Key use cases include health risk assessments (HRAs), post-discharge follow-up, risk profiling, care gap closure, and member enrollment outreach.
• The partnership directly addresses clinical workforce shortages by automating high-volume, routine outreach and freeing nurses to focus on complex, high-acuity cases.
• GuidingCare customers can deploy Sage quickly through a referral partnership, with conversation flows configurable to their specific clinical goals and workflows.

Scaling Smarter with Sage and GuidingCare

Health plans are under pressure to meet increasing demands for member engagement, care coordination, and improved clinical outcomes. But the ongoing healthcare workforce shortage makes it difficult for payers to scale resources.

The result is familiar: care managers are stretched thin by outreach and administrative requirements, reducing the time they can spend proactively engaging with patients and assessing potential gaps in care.

Payers need a scalable way to automate member outreach. That’s why HealthEdge® partnered with Ellipsis Health to integrate Sage, an AI-powered voice agent for care management, directly into the GuidingCare platform. Sage enables health plans to

automate outbound calls, broaden member reach, drive proactive health management, and lower administrative costs.

What Is AI-Powered Virtual Nursing?

AI-powered virtual nursing tools use conversational AI to conduct phone-based outreach with health plan members. Unlike traditional automated calls or Interactive Voice Response (IVR) systems, AI-powered voice agents like Sage are designed to hold natural, emotionally intelligent conversations—and adapt in real time based on how a member responds.

How Sage Works—and How it Stands Out

The new partnership between HealthEdge and Ellipsis Health makes AI-powered virtual nursing available to GuidingCare users. Sage is integrated within the GuidingCare ecosystem, allowing it to draw from existing member information to personalize each conversation and deliver updated information from these interactions back into the platform.

For health plans already using GuidingCare or Wellframe, it’s a seamless extension of their existing care management infrastructure.

Sage is not a scripted phone bot. Instead, it mirrors human conversation—including intonations and natural pauses—using Ellipsis Health’s patented sentiment matching technology, which was trained using millions of live clinical patient calls. This allows Sage to engage in active listening and interviewing, and adjust its responses according to member cues.

What does this look like for health plan members? During conversations, Sage can:

• Deliver affirmations and acknowledgements that reflect active listening
• Recognize emotional cues, like irritation, sadness, or confusion
• Calmly redirect conversations to stay focused on the goal of the call

Why is this important for health plans? Because member engagement is more than a checklist of questions asked over the phone. It’s about building a trusting relationship with members so they feel supported and actively involved in their own health.

Where Health Plans Can Put Sage to Work

Sage helps payers address the highest-volume, most time-intensive outreach tasks care management teams face. Configurable to each health plan’s clinical goals and workflows, Sage supports:

• Clinical workforce optimization: Extend the reach of care managers with automated routine outreach and empower staff to focus on high-acuity cases and help support more members.
• Predictable cost savings: The technology behind Sage enables cost-efficient, scalable outreach and delivers rapid ROI with improved engagement outcomes.
• Seamless ecosystem integration: GuidingCare customers can quickly deploy this AI solution via referral partnership, enabling customized engagements based on health plan’s individual goals, as well as Medicare and Medicaid requirements.
• Health risk assessment (HRAs) completion: Scale outreach to meet regulatory, quality, and risk adjustment requirements. Sage conducts the full HRA in a single outreach call and adds updates to GuidingCare automatically.

Sage gives care management teams back hours of time per week—time that can be redirected toward the members who need the highest levels of clinical expertise and intervention.

“As a nurse, I’ve seen and experienced what happens when care managers are stretched thin,” says Marla Kraak, Product Director of Care Management at HealthEdge®. “Members fall through the cracks—not because anyone stopped caring, but because there simply aren’t enough hours. An AI voice agent that can handle routine HRA outreach and flag members who need a real conversation isn’t replacing the nurse. It’s making sure the nurse shows up where it counts.”

Scaling Engagement Without Sacrificing Quality

A core challenge in care management is finding the right balance between scale and quality. Reaching more members matters, but so does ensuring those interactions remain meaningful, effective, and capable of driving better outcomes at a lower total cost of care. Sage is built to engage entire member populations simultaneously, enabling health plans to scale high-volume outreach far beyond what manual efforts alone can support. With conversations that are personalized, clinically grounded, and emotionally aware, Sage helps plans identify needs earlier, close gaps in engagement, and guide members toward the right interventions before issues escalate into more costly utilization.

For health plan decision makers focused on lowering total cost of care, that combination matters. Timelier outreach, better member navigation, and stronger follow-through can help reduce avoidable emergency department visits, unnecessary utilization, and delays in care—while supporting more efficient use of care management resources.

For health plan IT leaders, integration details are equally important. Sage connects directly to the GuidingCare platform, allowing member data and outcomes to flow seamlessly between systems without manual reconciliation or another disconnected point solution to manage. The result is a more unified platform that supports both operational efficiency and more cost-effective care management at scale.

A Practical Path Forward for Care Management Leaders

With Sage, the combination of clinical intelligence, emotional design, and seamless platform integration empowers health plans to extend their existing resources and better support members across the risk spectrum.

GuidingCare customers: Want to learn more about elevating your care management strategy with Sage? Contact your Customer Success Executive for a demo.

Not yet a HealthEdge customer? Download the Care Solutions data sheet to learn how your health plan can leverage AI-driven tools within your care management operations.

Frequently Asked Questions

What is Sage, and how does it differ from a standard automated phone system?

Sage is an AI care management voice agent developed by Ellipsis Health. Unlike traditional IVR or scripted call systems, Sage uses a patented Empathy Engine to analyze vocal cues in real time and adapt its responses based on emotional signals. It’s trained on millions of live clinical patient calls, making it capable of holding natural, clinically informed conversations with members.

How does the HealthEdge and Ellipsis Health integration work?

Sage integrates directly with HealthEdge’s GuidingCare platform. It draws on member data stored in GuidingCare to personalize outreach conversations, and it returns outcomes back into the platform once calls are completed. This creates a closed-loop workflow with no manual data reconciliation required.

What types of care management programs can Sage support?

Sage supports a range of high-volume outreach programs, including health risk assessments, post-discharge follow-up calls, risk profiling, care gap closure, and member enrollment outreach. Conversation flows are configurable to each health plan’s specific clinical goals and compliance requirements.

How does this partnership address clinical workforce shortages?

By automating routine, high-volume outreach tasks, Sage frees nursing staff to focus on complex, high-acuity cases that genuinely require clinical expertise. Health plans can engage entire member populations simultaneously without adding headcount, making care management programs more scalable and cost-efficient.

Is this solution compatible with Medicare and Medicaid programs?

Yes. Sage is designed to be highly configurable, allowing health plans to align conversation flows to the specific requirements of Medicare, Medicaid, and other program types. GuidingCare customers can work with their Customer Success Executive to configure deployments accordingly.

What is a health risk assessment, and why does it matter for health plans?

A health risk assessment (HRA) is a structured set of questions designed to evaluate a member’s general health status, lifestyle factors, and potential care gaps. For payers, HRAs are critical for risk adjustment, quality reporting, and regulatory compliance. Completing them at scale—and accurately—directly affects a health plan’s risk profile and program performance.

How quickly can GuidingCare customers deploy Sage?

Sage is available to GuidingCare customers through a referral partnership, designed for efficient deployment. Health plans can contact their HealthEdge Customer Success Executive to begin the process and explore configuration options aligned to their care management strategy.