Closing the Loop at Scale
Pear is a value-based care operating system that goes full circle: Chart → Call → Close. Our AI reviews every patient chart, identifies care gaps, makes outreach calls, and closes gaps automatically—generating VBC revenue while freeing your care team.
We're going to follow Dorothy Johnson, a 72-year-old patient with Type 2 Diabetes, Hypertension, and Hyperlipidemia who's been skipping her Atorvastatin due to concerns about side effects. You'll see how Pear coordinates across patient, pharmacy, and provider to convert her to mail order—closing the adherence gap in just 9 days with zero staff time.
This case study shows the complete workflow: from AI-powered chart review, to patient outreach, pharmacy coordination, provider tasking, and verification—all automated, all documented.
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Meet Dorothy
72 years old, African American female
Medicare Advantage
Last A1c
7.8%
Previous: 7.2%
Trending up (6 months)
Social Determinants
The Challenge: Dorothy's A1c is rising, and she's documented as skipping her Atorvastatin due to concerns about side effects. Traditional outreach often fails patients like Dorothy—the coordination between patient, pharmacy, and provider breaks down after 2-3 manual attempts.
Before any call is made, PEAR reads Dorothy's chart
|
Atorvastatin 40mg
23 days since last fill (due for refill)
Documented adherence barrier
Concerns about muscle aches
Transportation barrier
Limited pharmacy access window
Mail order candidate
Patient expressed interest but needs guidance
Dorothy isn't just a name on a call list.
She's a prioritized intervention with a documented pathway to success.
PEAR initiates outreach with context from the chart already loaded.
Patient Outreach
PEAR AI (Sarah)
Hi Dorothy, this is Sarah calling on behalf of Dr. Martinez's office. I'm checking in about your medications. I see your Atorvastatin refill is coming due—how has that been going for you?
Dorothy
I've been a little worried about it. I heard it can cause muscle problems.
PEAR AI (Sarah)
I understand that concern. Many patients worry about that. Have you experienced any muscle aches or weakness since starting it?
Dorothy
Not really, but I sometimes skip it just to be safe.
PEAR AI (Sarah)
I see. Dr. Martinez would want to know about that. I also see you were interested in mail order—that could make things more convenient with 90-day supplies delivered to your door. Would you like me to help set that up?
Dorothy
That would be nice. Afternoons are better for calls—after my shows. Maybe around 2?
PEAR AI (Sarah)
Perfect. I'll call you tomorrow at 2pm. Talk soon, Dorothy.
System Logs
Within 90 minutes, PEAR coordinates with the pharmacy to verify status and requirements.
Pharmacy Coordination
PEAR AI (Sarah)
Hi, I'm calling from Dr. Martinez's office regarding Dorothy Johnson, DOB 4/15/1952. I'm confirming her Atorvastatin prescription status and checking if this can be converted to a 90-day mail order supply through Caremark.
Pharmacy Tech
Let me check... Yes, she has refills remaining. For mail order, it would need to go through CVS Caremark directly. The prescriber would need to send a new 90-day script.
PEAR AI (Sarah)
Got it. Is Atorvastatin covered under her insurance plan?
Pharmacy Tech
Yes, it's active through August.
PEAR AI (Sarah)
Perfect. We'll coordinate the new prescription from the provider's side. Thank you.
System Logs
An automated task appears in the care team's inbox with everything they need to act.
via EHR inbox
Patient:
Dorothy Johnson (DOB 4/15/52)
Request:
90-day mail order prescription for Atorvastatin 40mg
Reason:
Patient has concerns about side effects; education provided; mail order with 90-day supply will improve convenience and adherence
Coverage Status:
Active through August
Priority:
Medication adherence gap
Action Needed:
Send 90-day Rx to CVS Caremark mail order
Dr. Martinez's MA approved
Script sent that afternoon
PEAR calls Dorothy back at her preferred time to close the patient loop.
Follow-up
PEAR AI (Sarah)
Hi Dorothy, it's Sarah again from Dr. Martinez's office. Good news—I've got your mail order all sorted out. Dr. Martinez sent a 90-day prescription to CVS Caremark. They'll deliver your Atorvastatin right to your door, and you'll only pay one copay for three months instead of three separate copays.
Dorothy
Oh that's wonderful! So I don't have to do anything?
PEAR AI (Sarah)
Caremark will call you in the next day or two to confirm your address and payment. After that, it'll arrive in about 5-7 days. Dr. Martinez also wanted me to mention that the 40mg dose you're on is well-tolerated by most patients, and to let us know if you have any actual muscle pain. I'll check back next week to make sure everything arrived okay.
Dorothy
Thank you so much, dear. That makes me feel better about taking it.
System Logs
Final verification confirms delivery and adherence. Gap is officially closed.
Verification
PEAR AI (Sarah)
Hi Dorothy, it's Sarah checking in. Did your Atorvastatin arrive in the mail?
Dorothy
Yes! It came yesterday. Three months worth—I couldn't believe it.
PEAR AI (Sarah)
That's great. And just to confirm—you're taking it every evening with dinner, right? Any muscle aches or concerns?
Dorothy
Yes, every evening. And no, I feel just fine—I think I was worried for nothing.
PEAR AI (Sarah)
Wonderful to hear. We'll check in again in about 90 days before your next refill is due. Take care, Dorothy.
System Logs
Patient informed
Mail order in process
Delivery confirmed
Adherence confirmed
Next outreach: Day 85
(pre-refill)
Gap Status
CLOSED
Comparing manual workflow to PEAR
| Metric | Before PEAR | With PEAR |
|---|---|---|
| Touches to close gap | 2-3 (then abandoned) | 4 (all completed) |
| Staff time | 45 min pharmacist time | 0 min (fully automated) |
| Time to resolution | Often unresolved | 9 days |
| Documentation | Inconsistent | Full audit trail |
| 90-day conversion | Rarely attempted | Systematically offered |
Dorothy's story repeats thousands of times across any MA population.
In a typical Medicare Advantage population:
Most adherence gaps persist because the manual workflow breaks down after 2-3 attempts.
For a 10,000-member MA plan
| Metric | Manual Approach | PEAR Approach |
|---|---|---|
| Patients flagged | 500 | 500 |
| Actually contacted | 200 (staff bandwidth) | 500 (100%) |
| Barriers identified | 80 | 400+ |
| Mail order conversions | 30 | 150+ |
| PDC achieved | 92% | 95%+ |
Each loop must complete for the gap to truly close
Gap Closed, Documented, Auditable
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