Care continuity means giving healthcare that is connected and meets patient needs through different steps and places. It makes sure that medical information, treatment plans, and patient support move smoothly from one care point to another. But, many problems stop care continuity in the United States:
These problems cause higher costs, inefficiency, provider burnout, and sometimes worse patient results.
AI has helped improve risk adjustment and coding accuracy. Correct risk adjustment means identifying and coding patient diseases properly using systems like Hierarchical Condition Categories (HCC). Coding mistakes can cause lost money or legal problems.
Franciscan Alliance, a large health group in the Midwest, worked with Innovaccer, a technology company, to improve care and coding. Using Innovaccer’s AI platform, Franciscan Alliance created $2.2 million in value from Medicare plans. The AI helped close coding gaps by 2.8%. This means missed codes were found and recorded, adding $312,000 in value.
Innovaccer’s platform works with any EHR system without big changes or data moving. This made it easier for Franciscan’s teams to add AI to their work. It improved documentation and saved time on manual checks.
The platform combines clinical and claims data to show a full picture of the patient. The AI finds coding chances that may have been missed and suggests fixes. This lowers paperwork and supports care models that depend on exact risk scores.
Care gaps happen when patients miss recommended services like screenings and follow-ups. Closing these gaps is important for health, chronic disease control, and quality reports like HEDIS and CMS Stars. Manual finding and following up are slow and uneven.
ZeOmega’s Jiva platform uses AI to automate care gap closure with advanced data and clinical info. Its Care Quality Navigator gathers all quality program data so care teams can find care gaps automatically. The system triggers “next best action” steps with personal reminders or outreach to keep patients on track.
The AI updates these steps based on new info or patient changes. It also uses social factors like housing and income to understand care barriers and help patients better.
Franciscan Alliance showed benefits with pre-visit planning. Automated workflows stopped 75 hospital visits and saved almost $870,000 for Medicare patients. Pre-visit checks made sure patients got the right screenings and medicine reviews before appointments. This lowered hospital stays and emergency visits.
Referral management and prior approvals cause delays in care coordination. Slow approvals and poor communication between providers, payers, and specialty clinics lead to treatment delays, more paperwork, and unhappy patients.
Onpoint Healthcare’s Iris Medical Agent AI Platform helps with referral and authorization problems using its NetworkFlow module. NetworkFlow allows real-time care coordination. It gives insights to streamline referrals, approve procedures, and schedule visits automatically. It also helps communication across providers.
This platform cuts false denials, speeds up payments, and lowers paperwork. Providers say that this saves time and lets them spend more time with patients instead of dealing with forms.
A multi-specialty medical group in the Midwest said Onpoint’s platform improved their 15-clinic network. Efficiency and patient results went up and staff felt better. The technology worked well with their current EHR systems and did not disrupt clinical work.
Clinicians spend a large part of their day on paperwork—over three hours. This includes documentation, coding, approvals, and coordinating care instead of seeing patients. AI workflow automation helps by doing many routine and complex tasks on its own.
Onpoint Healthcare’s Iris Platform uses different AI modules: ChartFlow, CodeFlow, CareFlow, and NetworkFlow. ChartFlow automates charting tasks like visit prep, medicine checks, and updating problem lists with 99.5% accuracy, checked by clinical auditors. Providers say they rarely need to fix notes, so they approve charts faster.
CodeFlow helps coding and compliance, cutting claim denials and speeding payments. CareFlow manages patient care over time by automating risk adjustment and care gap closure, lowering mental workload for providers.
This automation platform supports over 2,000 providers in more than 35 specialties. It covers the whole patient journey from before the visit to after. Providers save around 3.5 hours each day on paperwork, which can lower operating costs by up to 70%.
AI use for care continuity and workflow automation is growing in the U.S. healthcare system. Medium to large medical groups, safety-net providers, and integrated networks are adopting these tools. Groups like Franciscan Alliance and Onpoint Healthcare show how AI platforms improve revenue, patient satisfaction, and provider work-life balance.
Many medical leaders see AI as needed to meet stricter rules, support value-based care, and handle more patients effectively. These tools help providers stay competitive and follow regulations in a tough market.
Franciscan Alliance showed success by making millions while cutting readmissions and emergency visits. This sets an example for others wanting to use AI and data integration. Onpoint’s user feedback shows how AI reduces provider burnout by cutting heavy paperwork.
AI-driven workflow automation changes how care is given across the whole patient journey. Some important stages are:
Using AI in these steps helps healthcare run more efficiently. Care teams can spend more time with patients while keeping records accurate, following rules, and managing finances.
For U.S. medical practice administrators and IT managers, adopting AI automation isn’t just about new technology. These tools change workflows, staffing, and finances. Understanding and using AI platforms from Onpoint Healthcare, Innovaccer, or ZeOmega can help medical practices:
Adding AI solutions means careful work to fit existing EHR systems and strong teamwork between technical and clinical staff. But, these efforts can bring big rewards in better care and lower costs.
By focusing on automating risk adjustment, care gap closure, and referral management, U.S. healthcare practices can meet financial and clinical goals in a cost-effective and expandable way.
Ambient medical scribing refers to AI agents that document clinical encounters in real time without manual input. Onpoint Healthcare’s AI platform executes tasks autonomously, going beyond suggestions to perform charting, coding, and care coordination, streamlining documentation and improving accuracy to reduce provider administrative burden.
Onpoint Healthcare’s AI achieves an unmatched clinical accuracy of 99.5% by combining artificial intelligence with clinical auditors, ensuring high-quality and reliable clinical documentation, reducing errors and improving compliance.
Providers typically save over 3.5 hours daily in administrative tasks using Onpoint’s AI platform, allowing them to focus more on patient care and reduce documentation-related cognitive overload.
Onpoint’s platform can potentially reduce administrative costs by up to 70% through streamlined workflows, optimized operations, and minimizing errors in charting, coding, and care coordination processes.
The Iris platform integrates workflows across the patient journey—pre-visit, visit, post-visit, and care continuity. It automates clinical documentation, coding, risk adjustment, care gap closure, referral management, and prior authorizations, ensuring seamless and closed-loop coordination across providers and care teams.
ChartFlow delivers comprehensive AI-powered charting that extends beyond single visits. It covers visit preparation, medication and problem list reconciliation, inbox triage, and generates highly accurate, compliant clinical documentation promptly.
CodeFlow enhances coding accuracy and compliance by using smart AI tools to reduce administrative workload, minimize claim denials, accelerate reimbursements, and ensure adherence to evolving regulatory requirements.
CareFlow automates essential longitudinal management tasks such as HCC risk adjustment and care gap closure, creating customized EHR workflows. It supports care continuity and reduces cognitive overload for providers and care teams.
NetworkFlow facilitates real-time, closed-loop care coordination by providing actionable insights. It streamlines collaboration among providers, support teams, and payers for referrals and prior authorizations, supporting scalable implementations in large healthcare networks.
Onpoint’s AI platform seamlessly integrates with modern EHR systems, allowing smooth embedding into provider workflows. The modular platform supports over 2000 providers across 35 specialties, enabling start-to-finish automation while ensuring data accuracy and security.
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