The questions
practices actually ask.

No. Alema runs alongside your EHR — never replacing it. Your staff uses your EHR’s existing scheduling, charting, and billing tools. Alema is the intelligence layer that decides which patients to reach and proves the revenue afterward. Patients just get a short text with a booking link from your practice. Think of your EHR as the system of record, and Alema as the decision system that makes that record more valuable.

The SMS itself is deliberately generic — HIPAA’s minimum-necessary standard prevents us from putting “diabetes” or “discharge” in a text message. The message simply identifies your practice and asks the patient to tap the link. The link opens a secure, practice-branded booking page where they see the full reason — why we reached out, what’s covered by their insurance, what the next step is — and pick a time. Full transparency, full compliance, no PHI in the SMS body.

No. The link in the text opens directly in the patient’s phone browser — no app store, no login, no new credentials. They see a clean booking page, pick a time, complete a short intake, and they’re done. The whole flow takes under two minutes. Alema stays invisible to them. The only thing they notice is that their practice got more proactive and personalized.

Alema operates under a signed Business Associate Agreement with every practice we serve, and under BAAs with our infrastructure providers (AWS, our SMS carrier, our intake platform) so the entire chain is covered. We follow HIPAA’s minimum-necessary standard for SMS content — no PHI in the text body, just an action prompt and a link. All PHI lives on authenticated pages behind login. SMS consent is verified against each patient’s EHR record before any outreach is triggered. Opt-outs are honored instantly and logged with a timestamp for audit. Every action is recorded.

Every new practice starts in Pilot Mode. For the first week, Alema identifies opportunities and drafts outreach, but nothing is sent automatically — your team reviews and manually approves each message. This builds trust in the system and catches any configuration issues. Once you're comfortable, you enable Auto Outreach one engine at a time, on your timeline. You're in control the whole way.

Templates are locked by design — this is what keeps every message HIPAA-compliant and protects your practice from audit risk. What you can control: which engines are on, how many outreaches per day, which appointment types are bookable, your practice name and branding in every message, and the reimbursement rates used in revenue calculations. Staff can't edit template bodies, which means no one on your team can accidentally write something that creates liability.

Alema does not require you to drop other tools. For patients enrolled in Patient Passport, Alema sends messages directly through Elation's messaging system, so those communications appear in the same place patients are already used to seeing messages from your practice. For patients not yet on Passport, Alema sends SMS through a HIPAA-compliant texting infrastructure with the practice's own caller ID, with messages directing patients to your Elation Booking Site. Whether to keep, consolidate, or retire your existing texting platform is a decision practices make based on their specific workflows.

Alema produces ROI by automating outreach for revenue-generating clinical workflows that practices typically don't have staff capacity to execute consistently. Annual Wellness Visits, Transitional Care Management, no-show recovery, and inactive patient reactivation each represent identifiable revenue opportunities that exist in every primary care practice. Alema identifies these opportunities daily, reaches the right patients through the right channel, and writes activity back to your EHR. The pace of revenue capture depends on your practice size, payer mix, and patient response rates, all of which are measured and reported transparently in your Realized Revenue dashboard.

Every text Alema sends includes the standard STOP keyword. If a patient texts STOP, replies with any opt-out language, or asks not to be contacted, Alema records the opt-out instantly and removes that patient from all future automated outreach across every engine — not just the one that contacted them. The opt-out is logged with a timestamp so you can prove compliance later. The patient still appears in your dashboard under a Manual Action Needed list so your staff can choose to call them directly if that makes sense for the patient relationship, but Alema will never send them another automated message.

When your EHR marks an appointment as a no-show, Alema flags it on a No-Show Recovery work list. From there, your staff can fire a recovery text from the dashboard with one click, or set the engine to auto-send. The recovery message acknowledges the missed visit warmly and offers a one-tap rebooking link. Most no-shows are recoverable when reached within a few hours. If the patient rebooks, the new appointment shows up on the work list — if they decline or ignore the recovery, the practice decides whether to call or move on. Practice keeps full control.

Alema runs a multi-step cadence — typically two automated nudges spaced a week apart. If the patient still has not booked after the final nudge, they move into a No Response state on your dashboard. From there, your team can either call them directly, log the call result, or mark them as not interested. Alema does not send a third automated message because past that point, additional texts are more likely to feel like spam than to drive a booking. The handoff to manual follow-up is intentional — there is a point where human judgment matters more than automation.

Yes. Every outreach work list has a Log Outreach button next to the patient. If your front desk picks up the phone and calls the patient directly, they can log the call result — booked, declined, left voicemail, wrong number — in two clicks. That call counts toward the patient outreach history and updates their state, so Alema does not keep texting a patient your staff already spoke to. Manual call logging is fully supported as a first-class workflow, not a workaround.

Alema syncs with your EHR appointment data automatically. When a patient books through the link in their text — or even if they book through any other channel — the new appointment writes to your EHR schedule, and Alema sees it on the next sync. The patient outreach state updates from Outreached to Booked, and the appointment shows up on your Today’s Schedule view with a flag noting which Alema engine triggered the booking. Attribution is automatic. Staff does not have to mark anything.

Every practice has its own billing cadence — some bill same-day, some bill weekly, some are slower. Alema does not impose a deadline. After a visit is marked seen, it stays in the Seen state until your EHR confirms a billed claim, at which point it moves to Billed automatically. If a patient was scheduled but did not actually attend, your front desk can hit a No Show button at any time — immediately after the missed slot, or three days later when the biller notices, whichever fits your workflow. The practice controls the timing, not Alema.

You do not pay anything until Alema has actually generated $249 in attributable revenue for your practice. That means: Alema texts your patients, they book, you see them, you bill the visit, and only after that revenue clears does Alema start charging you the $249 monthly subscription. The threshold is performance-based, not promise-based — if Alema does not produce revenue, you do not get a bill. Once the threshold is crossed, your subscription activates and renews monthly. We earn it before we charge it.

Alerts and the dashboard start the same day you connect your EHR — you can see your revenue gaps, your AWV-eligible patients, your overdue TCM windows, and your inactive panel within minutes of signup. Outbound texting takes a bit longer because federal carrier rules require all business SMS senders to register their brand and campaign with the major mobile carriers first. That registration typically clears within 5 to 7 business days. During that window, your dashboard is fully live — you can run reports, work the lists manually, log calls, and see all the same data Alema will eventually text on your behalf. The moment carrier registration clears, automated outreach turns on with no extra steps.

Honest answer: it depends on your panel, your payer mix, and your patient response rates. But the math is straightforward. Medicare’s 2026 national averages: Initial Annual Wellness Visits reimburse around $174, subsequent AWVs around $138. Moderate-complexity TCM (99495) reimburses around $201, high-complexity TCM (99496) around $273. A typical independent primary care practice with 500 Medicare patients has 100–150 AWV-eligible patients sitting on the panel at any given time and 10–20 monthly discharges that qualify for TCM. Capture rates without automation hover around 30–40%. Practices that systematize outreach — the kind of consistent multi-touch follow-up Alema runs by default — historically push capture rates into the 60–80% range across these revenue categories. That is the gap Alema is built to close. Your Realized Revenue dashboard tracks every dollar Alema attributed in real time so you can see your actual numbers, not someone else’s.

No. Alema is month-to-month, no contracts, no annual commitments, no exit fees, no minimums. You can cancel at any time from your settings page. We do not believe in trapping practices into multi-year deals — every revenue platform on the market does that, and it never serves the customer. We want to earn your business every month, forever. The day Alema stops producing more revenue than it costs, you should leave. We will give you the export, walk you through the offboarding, and wish you well. That confidence is why we charge nothing until we have already produced $249 in attributable revenue for you.