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Patient Navigation as a Service

Quality of care outside of your office is just as important as it is inside your office.

One patient over two monthsan example, not a real person

What we can do for you in one week

This is what our first week looked like on a 385 patient Medicare panel where 188 patients still needed an AWV.

Patients we worked0

Called, took note of, or chart prepped, in the first week.

Charts we prepped0

The AWV template and the code were on the visit before it happened.

AWVs we booked0

Visits on the schedule that were not there before we called.

Miscoded visits we found0

Billed as follow-ups when they were wellness visits. About $4,000 waiting on a code.

One person made every call. The full case study, with the practice's name, comes at sixty days.

Our system

We do everything but the visit itself.

1

We find who is due

Based on your EHR, we pull patient charts and automatically determine who is eligible and due for an AWV.

2

We call them and book them

Our system decides who to call, in what order, and when. A real person makes the call.

3

We prep the chart before the visit

Once a visit is booked, we add it to your schedule, template the chart, and make sure it is coded to close the gap.

4

We verify every closure

We reread the chart after the visit to make sure the code went through with the locked note. We do not count the AWV as closed until it is billed.

Pricing

You pay a flat monthly rate for each patient who is due, and only for the months they stay due. When a patient is seen, they come off the list. We never charge more than three months for the same patient.

For your first sixty days

Pilot

A reduced rate to prove it on your panel and get your list caught up.

  • Your full due list, worked from day one
  • Every call made by a real person
  • Charts prepped and coded before the visit
  • Results on your desk within the first week
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For a primary care practice

Practice

The full service, month to month, on the patients who are due.

  • Everything in the pilot
  • The corrected due list on the first of every month
  • Miscoded visits found and sent to your coder
  • Every closure verified after the visit
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For an ACO or MSO

Enterprise

A negotiated rate across the practices you name, and a share of the lift in shared savings we bring you.

  • Everything in Practice, for every practice
  • Measured against a control group
  • A quarterly report against your own numbers
  • One BAA
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How we start

Sixty days on your panel. We need three things from you.

1

A BAA

One page, ours or yours.

2

A read-only login to your EHR

This is how we pull the charts. We sit on top of eCW, never against it.

3

A line on your phone system

So our calls come from your number, recorded with notice.

We start as soon as we receive all three, and you will see results within the first week.

Our program agnostic AI architecture

The same machinery expands into many more valuable programs. Today we do AWVs. With the addition of new rules engines, we will be able to do CCM, TCM, APCM, and close the other HEDIS gaps, all with the same engine. A new program is rules dropped into the engine, not another vendor for you.

Your patient chartspulled from your EHR every night
Payer and ACO gap listswe check them against the chart
Your schedulewho is booked, seen, or no-showed
Faxes and outside resultsmammograms, colonoscopies, labs
Every call and notewhat our staff learned from the patient
The Arbor engineone record per patient, one rulebook per program
385charts read every night
159call notes learned from in week one
1program live, eleven planned
The system does everything but the call
Programs
Wellness visits
Colonoscopy and Cologuard
Mammograms
Diabetes control
Chronic care (CCM)
Advanced primary care (APCM)
Navigation (PIN)
Community health (CHI)
Transitions (TCM)
Eligibility, day ahead
Fax intake
Coding and claims
Call this patientwho, when, and what to say
Prep this chartthe template and the code on the visit
Order this Cologuardand chase the result
Flag this to the doctoronly what needs a clinician

We will be your one stop shop for the care that happens outside your office.

Our agentic system, with a human in the loop

How we work, and what we will never do.

We decide who is due from the chart.We check the payer's list against the chart, and the chart wins.
We only count a visit as ours if we touched the patient first.If your office booked it, it is yours, and we say so.
The system does everything but the calls.It decides who to call, when, and what to say. A human makes the call to keep the quality of care high.
It learns from every outcome.Every call, note, booking and visit is logged. When a person corrects the system, it remembers why and does not make that mistake again.
We sit on top of your EHR, never against it.We pull every chart over the FHIR API nightly. Nothing is typed into eCW by a machine.
Built for PHI.Encrypted at rest and in transit, every practice walled off from every other, every access logged, and no patient data to any model that is not HIPAA-eligible.