AH

ACUITYhealth

Comprehensive Care Platform (CCP)

Transforming Home Health into Revenue-Generating Care Coordination

An end-to-end ambient intelligence platform that seamlessly captures home health interactions through passive listening, maps clinical conversations to billable CPT codes via an 11-chevron framework, and delivers personalized care through AI-powered digital twin avatars—enabling providers to generate $3,600+ annual revenue per patient while reducing documentation time by 85%.

300+

Patients per Provider

98%

Clean Claim Rate

45 Days

ROI Payback

Technical Platform Documentation | Version 2.0

1

ACUITYhealth Comprehensive Care Platform (CCP)

Unified Payer-Provider-Person Ecosystem

CCP
Core

PERSON Digital Twin Avatar

PROVIDER NP/MD Portal

PAYER Value Analytics

Platform Architecture: End-to-end ambient listening infrastructure capturing home health interactions, transforming utterances into billable care coordination activities through an 11-chevron framework, delivered via personalized digital twin avatars.

$3,600

Annual Revenue/Patient

85%

Documentation Reduction

6x

Provider Capacity

98%

Clean Claim Rate

Tri-Stakeholder Value Creation

PERSON (Patient) Benefits

• 24/7 Digital Twin Avatar providing personalized health coaching
• 25% reduction in hospital readmissions
• 30% improvement in medication adherence
• 3x higher engagement vs traditional portals
• Zero additional cost - covered by insurance
• Proactive care preventing acute episodes

PROVIDER (NP/MD) Benefits

• $3,600 additional revenue per patient annually
• 85% reduction in documentation time
• 6x increase in patient panel capacity (300+)
• 5-minute monthly review vs 30-minute documentation
• 98% clean claim rate with auto-coding
• Zero staffing increase required

PAYER (Insurance) Benefits

• $4,800 reduction in total cost per patient
• 20% decrease in ED utilization
• 15-20% improvement in Star Ratings
• HEDIS measure automation for quality reporting
• Risk adjustment optimization improving RAF scores
• Predictive analytics preventing high-cost events

2

Ambient Listening Technical Architecture

OASIS-Aligned Passive Capture System

Home Visit
RN/PT/OT/ST

→

Ambient Capture
HIPAA-Compliant

→

NLP Processing
Utterance Extraction

→

Chevron Mapping
Auto-Classification

Technical Pipeline Components

Audio Capture Layer: Edge processing with 256-bit AES encryption
Speech-to-Text Engine: Medical-tuned ASR with 98.5% accuracy
NLP Classification: BERT-based model trained on 2M+ OASIS assessments
Billable Detection: Real-time CPT/HCPCS code mapping algorithm
Data Lake: FHIR-compliant storage with HL7 integration

OASIS Question → Billable Code Mapping

M1021/M1023 (Diagnoses)
→ CCM/PCM 99490/99426

M2001-M2005 (Medications)
→ TCM 99495/99496

D0150 (PHQ-2/9)
→ BHI 99484

M1400 (Dyspnea)
→ RPM 99457

Q0400 (Goals)
→ ACP 99497

C0500 (BIMS)
→ Cognitive 99483

Ambient Listening Tri-Stakeholder Impact

PERSON (Patient) Benefits

• Natural conversations count toward care time
• Nothing missed - all concerns captured automatically
• More face-to-face time with nurses (not typing)
• Comprehensive care plans from every interaction
• Family statements included in care coordination
• Privacy protected with HIPAA-compliant encryption

PROVIDER (NP/MD) Benefits

• 60-80 billable items captured per OASIS visit
• Zero manual entry - all auto-populated
• 99.2% documentation accuracy vs 65% manual
• Nurse conversations billable as CCM time
• <2 second latency from utterance to code
• $150-250 monthly revenue from missed items

PAYER (Insurance) Benefits

• Complete audit trails with timestamps
• 92% correlation between OASIS and billing codes
• Reduced fraud risk through verification
• Early intervention detection from utterances
• SDOH factors captured improving risk models
• Quality measure automation from conversations

3

11-Chevron Comprehensive Care Framework

Billable Activity Orchestration Engine

Architecture Principle: Each chevron represents a discrete microservice capturing specific billable interactions, orchestrated through a central API gateway with real-time event streaming.

1. Clinical Updates
Diagnoses & Symptoms CCM/PCM

2. Financial Metrics
Cost & Savings Value-Based

3. Operations
Care Coordination CCM Time

4. Engagement
Patient Interaction BHI/CCM

5. Risk Management
Predictive Analytics HCC/RAF

6. Quality Measures
HEDIS/Stars Quality Bonus

7. Utilization
Resource Tracking TCM/CCM

8. Workforce
Staff Activities 99439

9. Compliance
Audit Trail Documentation

10. Outcomes
Results Tracking Performance

11. Alerts
Real-time Response Critical Care

COMPASS DASHBOARD
Unified Command Center All Codes

11-Chevron Framework Tri-Stakeholder Impact

PERSON (Patient) Benefits

• Holistic care view across 11 life domains
• Personalized goals tracked in real-time
• Mental health integrated not isolated
• Daily wins celebrated improving motivation
• Care team coordination visible and active
• Progress dashboard showing health journey

PROVIDER (NP/MD) Benefits

• 8-12 billable items per chevron monthly
• Cross-chevron billing multiplies revenue
• 120-180 minutes captured monthly
• Automatic code mapping prevents misses
• $250-350 monthly per patient revenue
• Unified dashboard for all billable activities

PAYER (Insurance) Benefits

• Comprehensive risk view across all domains
• Quality measures mapped to each chevron
• Duplicate billing prevented by design
• Predictive analytics from pattern detection
• Outcomes tracking tied to interventions
• Value demonstration through chevron metrics

4

Digital Twin Healthcare Navigator

AI-Powered Personalized Health Avatar

Technical Stack: LLM-powered conversational AI with real-time biometric integration, predictive modeling, and behavioral nudge engine delivering personalized health coaching while capturing billable engagement time.

Avatar Architecture Components

Biometric Input
RPM Devices

→

AI Processing
GPT-4 Medical

→

Personalization
ML Models

→

Engagement
Voice/Visual

Daily Digital Twin Interactions

Morning Health Check: PHQ-2 mood assessment + vital signs review BHI + RPM
Medication Reminders: Smart dosing alerts with adherence tracking CCM
Symptom Monitoring: Condition-specific assessments PCM
Care Coordination: Appointment prep and follow-up TCM
Behavioral Coaching: CBT-based interventions BHI
Goal Progress: Gamified health achievements CCM

78%

Daily Engagement Rate

4.2 min

Avg Session Duration

90-150

Monthly Billable Minutes

Digital Twin Avatar Tri-Stakeholder Impact

PERSON (Patient) Benefits

• 24/7 health companion always available
• Personalized coaching in preferred language
• 4.2 minute daily check-ins feel conversational
• 25% medication adherence improvement
• Gamified health goals increase motivation
• Crisis detection with immediate escalation

PROVIDER (NP/MD) Benefits

• 90-150 billable minutes monthly from avatar
• $150-200 additional CCM/BHI revenue
• 85% PHQ-2 completion vs 15% traditional
• Zero provider time for patient engagement
• Automated ACP conversations (60% initiation)
• $0.02 per interaction vs $15 nurse call

PAYER (Insurance) Benefits

• 20% reduction in readmissions
• 18% fewer ED visits through early intervention
• 0.8% HbA1c reduction in diabetics
• 40% improvement in depression scores
• 15-point PAM increase (patient activation)
• $2,400 saved per prevented admission

5

Provider Portal Technical Architecture

5-Minute Attestation Workflow Engine

Provider Interface: React-based SPA with GraphQL API, real-time WebSocket updates, and one-click attestation workflow reducing documentation time by 85%.

Technical Workflow Components

Auto-Population
Pre-filled Chevrons

→

Validation Engine
Threshold Checks

→

E-Signature
HIPAA Compliant

→

Claim Generation
Auto-Submit

Provider Dashboard Features

CHI Risk Score: Real-time population health stratification (Red/Yellow/Green)
Billable Time Tracker: Live accumulation of CCM/PCM/BHI/RPM minutes
Code Optimizer: AI suggestions for maximum reimbursement capture
Compliance Monitor: Automated alerts for documentation gaps
Revenue Dashboard: Real-time earnings and projections
Batch Attestation: Review 50+ patients in 15 minutes

3-5 min

Per Patient Review

300+

Patients per Provider

94%

Pre-fill Accuracy

Provider Portal Tri-Stakeholder Impact

PERSON (Patient) Benefits

• Provider sees full picture in real-time
• Faster clinical decisions with complete data
• More provider face-time vs documentation
• Care continuity across all touchpoints
• Proactive interventions from risk scores
• Personalized care plans updated monthly

PROVIDER (NP/MD) Benefits

• 3-5 minutes per patient monthly review
• 300+ patient capacity per provider
• $20-25K monthly revenue generation
• 94% pre-fill accuracy reduces errors
• Batch attestation for 50+ patients in 15 min
• 45% burnout reduction from efficiency

PAYER (Insurance) Benefits

• 100% attestation compliance documented
• Risk stratification improves RAF scores
• Quality gaps closed through dashboards
• Fraud prevention via automated checks
• Timely interventions reduce costs
• HEDIS compliance tracked automatically

6

Payer Integration & Value Analytics

Real-Time Claims & Quality Reporting Engine

Payer Interface: EDI 837/835 automated clearinghouse with real-time eligibility verification, prior auth automation, and predictive denial management achieving 98% first-pass payment rate.

Payer Integration Components

Eligibility Engine
Real-time 270/271 verification

Prior Auth AI
278 automated submission

Claims Processing
837P/I batch generation

Remittance Parser
835 ERA processing

Denial Management
ML-powered appeals

Quality Reporting
HEDIS/Stars automation

Value-Based Contract Performance

Shared Savings Tracking: Real-time PMPM monitoring with variance alerts
Risk Adjustment: HCC gap closure with RAF score optimization
Quality Bonuses: Automated HEDIS measure submission
ACO Attribution: Patient panel management and leakage prevention
Bundle Analytics: Episode cost tracking with outlier detection

Payer Integration Tri-Stakeholder Impact

PERSON (Patient) Benefits

• Real-time eligibility prevents surprises
• Prior auth automation speeds treatment
• Zero out-of-pocket for CCM services
• Faster approvals for needed services
• Transparent benefits understanding
• No claim denials with pre-verification

PROVIDER (NP/MD) Benefits

• 98% first-pass payment rate
• 18-day payment vs 45 days traditional
• Automated appeals with 95% success
• $125-200 quality bonuses per patient
• Zero manual claims submission
• Real-time revenue tracking dashboard

PAYER (Insurance) Benefits

• Automated HEDIS reporting compliance
• RAF score optimization improves accuracy
• Reduced fraud through verification
• 35% lower admin costs from automation
• Value-based success tracking real-time
• Shared savings achievement visibility

7

Revenue Optimization & Billing Automation

CPT/HCPCS Code Maximization Engine

Billing Intelligence: ML-powered code optimizer analyzing utterance patterns to maximize legitimate reimbursement while maintaining 100% compliance through automated threshold monitoring.

Automated Revenue Streams

$65-113

CCM Monthly

$84-155

PCM Monthly

$50-143

RPM Monthly

$71

BHI Monthly

$86-161

ACP Quarterly

$195-296

TCM per Discharge

Code Optimization Algorithm

Threshold Monitoring: Real-time tracking of 20/30/60-minute increments
Cross-Code Detection: Identifies compound billing opportunities
Modifier Intelligence: Automatic application of GT, 95, GO modifiers
Bundling Prevention: Alerts for NCCI edits and MUEs
Tier Optimization: Automatic escalation to complex codes when eligible

Revenue Optimization Tri-Stakeholder Impact

PERSON (Patient) Benefits

• Maximum care coverage through proper coding
• All services captured for continuity
• No missed benefits due to coding errors
• Comprehensive care plans fully funded
• Additional services unlocked (BHI, ACP)
• Transparent care documentation available

PROVIDER (NP/MD) Benefits

• $3,600 annual revenue per patient increase
• 8-12 additional codes captured monthly
• 2% denial rate vs 18% traditional
• Automatic tier optimization maximizes payment
• 100% modifier accuracy vs 65% manual
• Real-time threshold alerts prevent underbilling

PAYER (Insurance) Benefits

• Appropriate utilization through accurate coding
• Reduced overpayments from bundling errors
• NCCI edit compliance automated
• Predictable costs from consistent coding
• Quality metrics aligned with payments
• Lower audit costs from accuracy

8

Security, Compliance & Audit Architecture

HIPAA-Compliant Infrastructure

Security Framework: SOC 2 Type II certified infrastructure with end-to-end encryption, zero-trust architecture, and blockchain-based audit trail ensuring 100% compliance and data integrity.

Technical Security Stack

Encryption Layer
AES-256 at rest, TLS 1.3 in transit

Identity Management
SAML 2.0 SSO with MFA

Access Control
RBAC with attribute policies

Audit Logging
Immutable blockchain ledger

Data Governance
FHIR R4 compliance

Threat Detection
AI-powered SIEM

Compliance Automation Features

Audit Trail: Every utterance → chevron → code → claim tracked with timestamps
Documentation Chain: Cryptographic proof of data lineage
Time Verification: GPS-validated visit locations with duration proof
Consent Management: Automated patient authorization tracking
Compliance Dashboard: Real-time MIPS/APM/HEDIS performance

Security & Compliance Tri-Stakeholder Impact

PERSON (Patient) Benefits

• 100% HIPAA protection of health data
• Encrypted conversations end-to-end
• Consent tracking for all data use
• Access transparency with audit logs
• Data portability rights protected
• Zero breaches with zero-trust architecture

PROVIDER (NP/MD) Benefits

• 98% audit defense success rate
• $12 avg recovery vs $287 industry
• 99.8% documentation completeness
• 15-20% malpractice premium reduction
• Blockchain audit trail irrefutable
• $45-75K annual audit cost savings

PAYER (Insurance) Benefits

• 95% fraud reduction through verification
• Complete audit trails for all claims
• MIPS/APM compliance automated
• $180K prevented recoupments annually
• Real-time compliance monitoring
• SOC 2 certified infrastructure

9

Technical Implementation Roadmap

90-Day Platform Deployment

Integration Architecture: RESTful API gateway with HL7 FHIR adapters supporting Epic, Cerner, Allscripts, athenahealth, and 50+ EHR systems via standardized webhooks and batch interfaces.

Phase 1: Days 1-30 (Foundation)

Week 1: EHR integration via FHIR APIs and HL7 interfaces
Week 2: Ambient device deployment and network configuration
Week 3: Provider portal customization and SSO setup
Week 4: Pilot with 10 patients, initial data capture

Phase 2: Days 31-60 (Scale)

Week 5-6: Expand to 50 patients, optimize NLP models
Week 7: Payer EDI connection and clearinghouse setup
Week 8: First billing cycle with automated claims

Phase 3: Days 61-90 (Optimize)

Week 9-10: Full panel enrollment (200+ patients)
Week 11: Digital twin avatar personalization launch
Week 12: ML model optimization based on outcomes

Day 45

Break-even Point

Day 60

First Payment

Day 90

Full Optimization

Implementation Tri-Stakeholder Impact

PERSON (Patient) Benefits

• Day 30: Enhanced care begins immediately
• Zero disruption to current services
• Avatar available by week 11
• Seamless integration with existing care
• No learning curve - intuitive design
• Immediate benefits from day 1

PROVIDER (NP/MD) Benefits

• Day 45: Break-even achieved
• Day 60: First payment received
• Day 90: $50K+ monthly revenue
• 8 hours training total investment
• 95% adoption rate by providers
• Epic/Cerner/Allscripts ready

PAYER (Insurance) Benefits

• Week 7: EDI connected and tested
• Day 30: Quality tracking begins
• Day 60: Cost reduction visible
• FHIR compliance from day 1
• Automated reporting reduces burden
• Predictive models improving weekly

10

Value-Based Care Architecture

CHI-Powered Continuous Risk Modeling

VBC Foundation: Continuous Health Index (CHI) neural architecture with 16 system-specific transformer subnetworks producing real-time, risk-adjusted health trajectories that quantify "value" through longitudinal improvement tracking rather than episodic snapshots.

CMS "5 Rights" Clinical Decision Support Framework

Right Information
CHI score + contextual reasoning

Right Person
Provider, care manager, patient

Right Format
Intuitive CCP chevrons

Right Channel
EHR, mobile, ambient voice

Right Time
Before adverse event occurs

TEFCA + QHIN Interoperability

Bidirectional Data Flow: Seamless exchange across hospitals, payers, and home health
FHIR + OASIS Integration: Longitudinal visibility across entire care continuum
Elimination of Data Silos: CCP becomes connective tissue for VBC ecosystems
Real-Time Quality Metrics: Ambient OASIS collection → instant performance tracking

16-Agent Neural Architecture for Population Health

Clinical Agents
Symptoms→Dx→Vitals→Labs

→

Context Agents
Meds→Encounters→SDOH

→

Synthesis Agents
ACA→Consolidation→Synopsis

→

CHI Score
Continuous Risk Index

$26B

Annual Preventable Readmissions

25%

Readmission Reduction

100%

Audit Traceability

VBC Architecture Tri-Stakeholder Impact

PERSON (Patient) Benefits

• Predictive prevention before crisis occurs
• Personalized risk reduction across 16 health systems
• Timely care escalation (visits, telehealth, meds)
• Improved health literacy through engagement loops
• Equity-focused care with SDOH integration
• Continuous monitoring vs episodic snapshots

PROVIDER (NP/MD) Benefits

• Automated quality documentation from ambient capture
• Risk-adjusted benchmarking for ACO performance
• Chronic care billing capture optimization
• Reduced administrative burden from automation
• Early intervention alerts prevent deterioration
• Bundled payment optimization through tracking

PAYER (Insurance) Benefits

• Transparent outcome metrics for contract validation
• Predictive risk scoring improves RAF accuracy
• Real-time cost containment through early intervention
• Shared savings visibility with PMPM tracking
• Quality bonus achievement via HEDIS automation
• Blockchain auditability for CMS compliance

Transforming VBC from Reporting Framework to Living Intelligence

Measuring, Managing & Maximizing Value Continuously

The CCP embeds Value-Based Care logic directly into AI and workflow layers: capturing quality automatically through ambient inputs, computing "value" in real-time via CHI modeling, connecting all stakeholders in closed-loop feedback, and documenting performance with provenance for reimbursement. VBC becomes adaptive intelligence—not retrospective reporting.

11

Platform ROI & Total Value Creation

Financial, Clinical & Operational Excellence

Total Platform Value: $3M+ annual revenue opportunity per 500 patients through comprehensive billable capture, operational efficiency, and clinical outcome improvements.

Financial ROI Matrix

$720K

Annual Revenue (200 pts)

$1.5M

Annual Revenue (500 pts)

$3M

Annual Revenue (1000 pts)

500%

12-Month ROI

45 days

Payback Period

1500%

3-Year ROI

Clinical Outcome Improvements

Readmissions: 25% reduction = $600K saved per 100 patients
ED Utilization: 20% reduction = $240K saved
Medication Adherence: 30% improvement = 0.8% HbA1c reduction
Star Ratings: 0.5-star increase = 5% bonus payments
Patient Satisfaction: +18 CAHPS points

Operational Excellence

Provider Capacity: 300+ patients per provider (6x increase)
Documentation Time: 85% reduction (saves 100 hrs/month)
Clean Claim Rate: 98% (vs. 78% industry average)
Staff Requirements: No additional clinical FTEs
Practice Valuation: 40-50% increase from recurring revenue

Total Platform Tri-Stakeholder Value Creation

PERSON (Patient) Benefits

• 25% fewer hospitalizations through prevention
• 30% medication adherence improvement
• 24/7 health companion always available
• 3x higher engagement than portals
• +18 CAHPS points satisfaction increase
• Zero cost - insurance covered services

PROVIDER (NP/MD) Benefits

• $3,600 annual revenue per patient
• 300+ patient capacity (6x increase)
• 85% time savings on documentation
• 500% ROI in 12 months
• 40-50% practice valuation increase
• 45-day payback period

PAYER (Insurance) Benefits

• $4,800 annual savings per patient
• 20% ED reduction ($240K per 100)
• 0.5 Star Rating increase = 5% bonus
• 25% admin cost reduction from automation
• 45% care gap closure improvement
• 98% clean claims reducing processing

The Future of Healthcare Delivery

$3,600 Per Patient Annual Value Creation

ACUITYhealth's Comprehensive Care Platform unifies Person, Provider, and Payer into a single ecosystem where everyone wins. By transforming passive home health visits into active revenue generation through ambient AI, we enable sustainable, scalable, and profoundly impactful healthcare delivery that benefits all stakeholders equally.

AH

Thank You

From the entire ACUITYhealth team, thank you for your interest in transforming healthcare delivery through our Comprehensive Care Platform.

Our Leadership Team

Srinivas Nimmagadda, M.D.

Founder, Chief Executive Officer

Jake Saunders, M.D.

Chief Medical Officer

Ricky Shinall, M.D. Ph.D.

Chief Science Officer

Grant Saunders

Chief Technology Officer

Brian Williams

Chief Operating Officer

Ready to transform your practice with the power of ambient AI?

Contact Us: srinivas@acuity.health

Predict Health. Empower Life.