What's the Difference?
As Belong Health expands its AI capabilities through our multi-agent clinical solution, understanding these concepts helps us make better decisions about implementing technology that serves our complex-needs patient communities in partnership with health plans.
🤖
AI Agent
A single AI tool designed to perform a specific task.
Think of it as a specialized assistant that handles one job really well.
- ✓ Focused on one task
- ✓ Follows set instructions
- ✓ Predictable outcomes
- ✓ Works independently
🧠
Agentic AI
An AI approach where systems act autonomously with goals and decision-making.
Like a team of intelligent assistants working together toward bigger objectives.
- ✓ Multi-step reasoning
- ✓ Adapts to situations
- ✓ Makes decisions
- ✓ Orchestrates multiple tools
🎯 The Key Difference
An AI Agent is like a specialized employee who does one specific job.
Agentic AI is like a department manager who coordinates multiple specialists, makes decisions, and adapts strategies to achieve broader business goals.
How This Applies to Belong Health's AI Implementations
🎙️ Belong Voice Agent powered by Althea LIVE
Type: AI Agent (Single-Purpose)
The Belong Voice Agent powered by Althea is a focused AI agent designed specifically for phone interactions with patients in our D-SNP, C-SNP, and ACO Reach programs. It handles appointment scheduling, provides information about chronic condition management programs, and connects members to care coordination services to name a few.
What it does:
- Answers member calls 24/7 for ACO Reach/D-SNP/C-SNP members
- Schedules care coordination appointments
- Provides information about special needs programs
- Routes complex cases to care team pods
🎯 Impact: Reduces wait times, improves member satisfaction, and allows care teams to focus on complex care coordination and clinical needs.
🧠 Multi-Agent Clinical Solution + Salesforce Force Agent IN PROGRESS
Type: Agentic AI (Platform-Level, Multi-Purpose, Decision-Making)
Our comprehensive Multi-Agent Clinical Solution is a platform of 6 specialized agents that work together to deliver agentic AI for complex care management. Salesforce's Force Agent will be invoked to take specific actions within Salesforce when needed, executing the orchestrated care workflows.
Core Foundation Agents:
- Clinical Safety & Guardrails: Real-time safety monitoring and emergency detection
- Clinical Knowledge & Guidelines: Multi-condition reasoning for ACO Reach/D-SNP/C-SNP populations
- Regulatory Compliance: Medicare/Medicaid compliance and documentation
- Member Context & Risk Intelligence: Intelligent risk identification and comprehensive member profiles
- Care Coordination & Network Intelligence: Provider network management and care team collaboration
- Orchestration & Reasoning Engine: The "brain" that coordinates all agents
🎯 Anticipated Impact: Proactive, safe, and compliant care management for complex dual-eligible populations, with reduced hospital readmissions and optimized Stars/HEDIS performance.
📊 Interactive Examples: See the Difference
Scenario: Patient Calls About Diabetes Medication
"I need to refill my diabetes medication"
🤖 AI Agent (Belong Voice Agent powered by Althea) Approach:
✓ Confirms member identity
✓ Looks up D-SNP/C-SNP benefit information
✓ Provides refill instructions and guidance
✓ Connects to care coordination services if needed
Handles this specific request efficiently but doesn't go beyond the immediate task.
🧠 Agentic AI (Multi-Agent Solution) Approach:
✓ Processes the refill request
✓ Clinical Knowledge Agent: Analyzes member's medication adherence history and identifies patterns
✓ Member Context Agent: Notes member missed last HbA1c test and identifies multiple chronic conditions
✓ Care Coordination Agent: Decides to proactively schedule diabetes management and CHF monitoring
✓ Orchestrator: Coordinates entire workflow including care team notification
✓ Salesforce Force Agent: Creates tasks in Salesforce and schedules care team actions
✓ Compliance Agent: Documents all actions meeting Medicare/Medicaid requirements
Multi-agent orchestration delivers comprehensive, safe, and compliant care coordination.
Scenario: Patient Discharged from Hospital
🤖 AI Agent Approach:
An AI agent might handle ONE task:
✓ Send automated discharge follow-up call
✓ Ask standard questions about recovery
✓ Log responses in system
Completes assigned task but requires humans to coordinate next steps and ensure safety/compliance.
🧠 Agentic AI (Multi-Agent Solution) Approach:
Multi-agent orchestration with parallel safety monitoring:
1️⃣ ADT Feed: Real-time hospital discharge notification triggers workflow
2️⃣ Member Context Agent: Analyzes member's full profile (age 78, CHF + diabetes, risk score 85)
3️⃣ Clinical Knowledge Agent: Applies CHF post-discharge protocol and guidelines
4️⃣ Safety Agent (Parallel): Monitors for emergency symptoms, medication risks, abuse indicators
5️⃣ Care Coordination Agent: Assigns care team pod, schedules follow-ups, arranges services
6️⃣ Salesforce Force Agent: Creates all tasks, appointments, and documentation in Salesforce
7️⃣ Compliance Agent: Ensures CMS Model of Care compliance, HEDIS measure tracking
8️⃣ Orchestrator: Monitors entire workflow, escalates issues, adjusts plans in real-time
Comprehensive, safe, and compliant care coordination with automatic safety monitoring.
Scenario: Launching New C-SNP Product
🤖 AI Agent Approach:
Multiple separate AI agents, each doing one job:
• Agent 1: Processes enrollment forms
• Agent 2: Sends welcome emails
• Agent 3: Schedules initial assessments
• Agent 4: Updates member records
Humans must coordinate between agents and handle compliance/exceptions.
🧠 Agentic AI (Multi-Agent Solution) Approach:
Intelligent end-to-end workflow with compliance and safety:
1️⃣ Orchestrator: Receives enrollment notification
2️⃣ Member Context Agent: Validates eligibility and analyzes chronic conditions
3️⃣ Clinical Knowledge Agent: Determines multi-condition management needs
4️⃣ Care Coordination Agent: Assigns care team pod, determines care intensity
5️⃣ Salesforce Force Agent: Creates member record, assigns PCP, sets up workflows
6️⃣ Compliance Agent: Ensures CMS Model of Care HRA completion within 90 days
7️⃣ Safety Agent (Parallel): Screens for elder abuse, SDOH and frailty risks
8️⃣ Orchestrator: Schedules comprehensive assessment and coordinates all touchpoints
9️⃣ All Agents: Collaborate to deliver safe, compliant, personalized onboarding
Multi-agent platform ensures safety, compliance, and clinical appropriateness at every step.
📋 Quick Comparison Table
| Characteristic | AI Agent | Agentic AI |
|---|---|---|
| Scope | Single, specific task | Multiple, coordinated tasks |
| Decision Making | Follows programmed rules | Makes contextual decisions |
| Autonomy | Executes assigned function | Plans and adapts strategies |
| Learning | Task-specific improvement | Learns from outcomes across workflows |
| Complexity | Simpler to implement | More sophisticated architecture |
| Use Case | Repetitive, well-defined tasks | Complex, multi-step processes |
| Belong Health Example | Belong Voice Agent powered by Althea handling member calls | Multi-Agent Clinical Solution + Salesforce Force Agent orchestrating care workflows |
🏥 Try It Yourself: Healthcare Scenarios
Click on scenarios below to see how AI Agent vs Agentic AI would handle each situation at Belong Health:
📞 DSNP/C-SNP Benefits Inquiry Scenario
Situation: C-SNP member calls asking about diabetes management program benefits
🤖 AI Agent (Belong Voice Agent powered by Althea):
✓ Confirms C-SNP enrollment status
✓ Looks up diabetes management program benefits
✓ Explains program features and eligibility
✓ Connects to care coordination if member needs more help
Call completed efficiently. Information provided accurately.
🧠 Agentic AI (Multi-Agent Solution):
✓ Provides C-SNP diabetes program information (same as agent)
✓ Member Context Agent: Analyzes member's conditions (diabetes + CHF + CKD)
✓ Clinical Knowledge Agent: Identifies member needs comprehensive diabetes management
✓ Care Coordination Agent: Determines member would benefit from interdisciplinary pod
✓ Salesforce Force Agent: Creates care coordination referral and tasks
✓ Safety Agent (Parallel): Screens for elder abuse, SDOH and frailty risks
✓ Compliance Agent: Ensures documentation meets CMS requirements
Transforms benefits inquiry into comprehensive care coordination opportunity.
💊 Complex Medication Management Scenario
Situation: D-SNP member with CHF + diabetes hasn't refilled critical medications in 45 days (3rd gap this year)
🤖 AI Agent:
✓ Sends automated refill reminder text
✓ Calls member with reminder message
✓ Logs attempt in system
Reminder sent. Waiting for member response. No safety monitoring or root cause analysis.
🧠 Agentic AI (Multi-Agent Solution):
✓ Sends refill reminder
✓ Member Context Agent: Analyzes pattern: 3rd gap this year indicates adherence crisis
✓ Clinical Knowledge Agent: Identifies critical meds: furosemide (CHF) and metformin (diabetes)
✓ Safety Agent (Parallel): Flags high-risk polypharmacy + adherence pattern
✓ Care Coordination Agent: Recognizes need for intensive case management
✓ Salesforce Force Agent: Creates urgent care team tasks and schedules pharmacy consultation
✓ Compliance Agent: Documents medication adherence gap for Stars HEDIS measures
✓ Orchestrator: Escalates to care team pod within 24 hours
Comprehensive response addressing safety, clinical, and social factors.
🏥 Care Transition Scenario
Situation: D-SNP member discharged after CHF exacerbation with high readmission risk and lives alone
🤖 AI Agent:
✓ Receives discharge notification
✓ Adds member to follow-up call list
✓ Sends discharge instructions via Relay Health Text
Standard protocol. No safety monitoring or risk-stratified care coordination.
🧠 Agentic AI (Multi-Agent Solution):
✓ ADT Integration: Real-time discharge notification triggers multi-agent workflow
✓ Member Context Agent: Calculates risk score 85 (Tier 1 - High Risk), identifies living alone
✓ Clinical Knowledge Agent: Applies CHF post-discharge protocol and multi-condition guidelines
✓ Safety Agent (Parallel): Monitors for red flags: weight gain, SOB, medication errors, elder abuse
✓ Care Coordination Agent: Triggers intensive case management + BMG home-based assessment
✓ Salesforce Force Agent: Creates comprehensive task list, schedules all follow-ups in Salesforce
✓ Compliance Agent: Documents CMS Model of Care requirements, HEDIS measures
✓ Orchestrator: Monitors all touchpoints, automatically escalates concerns
Comprehensive, safe, and compliant care transition with real-time monitoring.
📋 D-SNP Care Coordination Scenario
Situation: New D-SNP member enrolls with complex conditions: diabetes, CHF, CKD, and depression
🤖 AI Agent:
✓ Processes D-SNP eligibility
✓ Creates/Updates member record
✓ Makes welcome call
✓ Triggers member ID card mail
Administrative process complete. Care setup requires manual coordination.
🧠 Agentic AI (Multi-Agent Solution):
✓ Orchestrator: Triggers comprehensive onboarding workflow
✓ Member Context Agent: Analyzes conditions, calculates risk score, identifies social needs
✓ Clinical Knowledge Agent: Applies multi-condition management protocols for complex patient
✓ Safety Agent (Parallel): Screens for elder abuse, frailty risk, SDOH vulnerabilities
✓ Care Coordination Agent: Assigns interdisciplinary pod, schedules comprehensive assessment
✓ Salesforce Force Agent: Creates member record, assigns PCP, sets up care workflows
✓ Compliance Agent: Ensures CMS Model of Care HRA within 90 days, documents all requirements
✓ All Agents: Collaborate to deliver safe, comprehensive care coordination from day one
Platform ensures safety, compliance, and clinical appropriateness for complex populations.
💼 What This Means for Belong Health's Business
AI Agents
Best For:
- High-volume, repetitive member interactions
- 24/7 availability for ACO Reach/D-SNP/C-SNP members
- Immediate cost savings on member services
- Quick wins and fast deployment
Business Value:
- 📉 Reduced member services costs
- ⏱️ Faster response times for ACO Reach/D-SNP/C-SNP members
- 😊 Improved member satisfaction with specialized programs
- 👥 Care teams focus on complex coordination and clinical needs
Agentic AI
Best For:
- Complex care coordination for ACO Reach/D-SNP/C-SNP populations
- Proactive health management with safety monitoring
- Regulatory compliance and quality improvement
- Scalable platform for complex chronic disease management
Business Value:
- 📊 Better health outcomes for complex dual-eligible populations
- 🏥 Reduced hospital readmissions through proactive coordination
- ⭐ Higher HEDIS/Stars ratings via automated tracking and outreach
- 💡 Scalable platform delivering safe, compliant, and efficient care
- 🛡️ Built-in safety monitoring and elder abuse detection
- 📋 Automated compliance documentation and audit readiness
🎯 Strategic Advantage: Platform Approach
Belong Health's multi-agent platform provides unique advantages for serving ACO Reach/D-SNP/C-SNP populations:
Belong Voice Agent powered by Althea delivers immediate operational efficiency for routine member interactions.
Multi-Agent Clinical Solution + Salesforce Force Agent transforms care delivery through a comprehensive platform that ensures safety, compliance, and clinical appropriateness for the most complex patient populations.
Key Differentiators:
• Safety-First Design: Parallel safety monitoring prevents harm and detects elder abuse
• Compliance Built-In: Automated Medicare/Medicaid documentation and audit readiness
• Multi-Condition Expertise: Designed specifically for patients with 3-5 chronic conditions
• Regulatory Optimization: Built-in HEDIS/Stars measure tracking and performance optimization
Together, they create a comprehensive AI strategy that balances quick wins with platform-level transformation.
🎓 Key Takeaways
1️⃣ AI Agent = Specialist
Does one thing well. Belong Voice Agent powered by Althea excels at handling ACO Reach/D-SNP/C-SNP member calls efficiently.
2️⃣ Agentic AI = Platform
Coordinates multiple specialized agents, ensures safety, and adapts. Multi-Agent Solution orchestrates comprehensive care workflows with Salesforce Force Agent execution.
3️⃣ Both Have Value
AI Agents solve specific problems quickly. Agentic AI platforms transform complex healthcare delivery.
4️⃣ Right Tool for Right Job
Simple, repetitive member interactions → AI Agent
Complex care coordination with safety/compliance → Multi-Agent Platform
5️⃣ Belong Health's Strategic Advantage
Using both approaches with platform-level architecture to serve complex ACO Reach/D-SNP/C-SNP populations safely, compliantly, and effectively while improving operational efficiency.