NUDGE THEORY

ACUITYhealth: The Adaptive Care Behavioral Intelligence Framework

Why This Matters

Healthcare faces a $4.3 trillion crisis where 88% of outcomes depend on patient behavior, not clinical care. Meanwhile, CCM and RPM programs offer $100-180 PMPM but suffer from 60% dropout rates. Nudge theory bridges both gaps — making healthy choices automatic while transforming every behavioral intervention into billable documentation, creating a self-sustaining model that improves outcomes while generating predictable revenue.

OUR VISION: Transform every health decision • Power sustainable CCM/RPM programs • Create self-financing care models

The Acuity Advantage

By integrating nudge theory with our Continuous Health Index (CHI) digital twin architecture, we transform passive health monitoring into active behavioral change — making the right health choice the easy choice for 100,000+ patients while powering CCM and RPM programs.

Our CHI system analyzes 15 body systems in real-time (cardiovascular, pulmonary, renal, endocrine, neurological, etc.), creating a living digital twin for each patient. When any system shows deterioration, our behavioral engine instantly generates personalized nudges tailored to that patient's health literacy, preferences, and social determinants. This intelligent system enables proactive interventions before crisis points, while automatically documenting billable CCM minutes and maximizing RPM compliance. Every nudge interaction becomes a reimbursable touchpoint, creating a self-sustaining care model that aligns clinical outcomes with financial sustainability.

Behavioral Science Foundation

Why This Matters

Traditional healthcare assumes rational decision-making, but Nobel Prize winner Richard Thaler's groundbreaking research proves 95% of health choices are driven by unconscious biases and environmental cues. By understanding these behavioral drivers, we can architect choice environments that naturally guide patients toward better health outcomes without requiring willpower or complex decision-making.

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Default Effect

Automatically enroll patients in preventive care protocols with opt-out options. Industry studies show potential for 85% participation vs. 23% with opt-in.

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Salience

Highlight deteriorating CHI scores with subtle animations. Research shows potential for 3x faster response to health warnings.

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Timely Reminders

AI-powered nudges at optimal moments can increase medication adherence by up to 40% through circadian-aligned prompts.

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Social Proof

"90% of heart patients check BP daily" messages can increase low-engagement user activation by 60-70%.

💡 IMPACT: Nobel Prize-winning science meets real-time AI — reducing cognitive load while generating sustainable CCM/RPM revenue

Intelligent Nudge Architecture

Why This Matters

Manual interventions fail because they're reactive and generic. Our AI-powered architecture processes millions of health signals in real-time, personalizing nudges to each patient's unique behavioral patterns and health trajectory. This creates a self-learning system that continuously improves intervention timing, messaging, and modality for maximum impact with minimal burden.

Real-Time Nudge Flow

1 Data Ingestion
Symptoms + Vitals enter CHI Transformer network. Patient-reported symptoms via mobile app, RPM device streams (BP, glucose, SpO₂), and clinical notes processed through FHIR primitives. Each data point assigned temporal indexing for trend analysis.

2 CHI Analysis
System-specific delta calculation (ΔCHI) across 15 body systems. Transformer-based AI evaluates change from 7-day baseline. Thresholds: Mild drift (ΔCHI -3), Moderate decline (ΔCHI -5), Critical deterioration (ΔCHI -8). Updates occur within 200ms of data arrival.

3 Nudge Generation
Behavioral engine selects from 5 archetypes based on patient psychology, health literacy, and context. Considers time of day, previous response patterns, and social determinants. Message personalized for language, tone, and channel (text, app, voice).

4 Digital Twin Update
Visual feedback renders affected system changes (heart glow, lung opacity). Personalized message delivered via preferred channel. Twin animation reflects urgency level. Patient action tracked: response time, completion status, behavioral outcome.

5 Reinforcement Loop
ACA (Algorithm Coordinator Agent) measures response & optimizes future nudges. Updates ML weights for timing, messaging, and archetype selection. Documents interaction for CCM/RPM billing. Feeds outcomes to care team dashboard and adjusts patient risk stratification.

System Performance

Response Latency < 200ms

Nudge Personalization 15 CHI Systems

Behavioral Models 5 Archetypes

CCM/RPM Integration Auto-Documented

Population Coverage 100K+ Patients

5 Nudge Archetypes: Tailored Behavioral Interventions

📝 Prompt Nudge

Triggers immediate action when data is needed. "Time to log your blood sugar?"

🤝 Commitment Nudge

Reinforces behavior streaks. "You've tracked vitals 5 days straight — can we make it 7?"

👥 Social Proof Nudge

Normalizes adherence behaviors. "80% of heart patients check BP before breakfast."

🎯 Gain Frame Nudge

Emphasizes positive outcomes. "Every consistent log adds +3 CHI points this week."

📊 Feedback Nudge

Shows health improvements. "Your lungs improved +5 CHI since Monday — keep going!"

Each archetype is dynamically selected based on patient psychology, condition, and real-time context for maximum behavioral activation.

🔬 IMPACT: Each CHI system becomes a self-adjusting behavioral engine that automatically documents billable CCM/RPM touchpoints

Clinical Implementation

Why This Matters

Theory without practice is worthless. These real-world implementations demonstrate how nudges can achieve high compliance rates and rapid response times across diverse clinical conditions. Each example shows the precise trigger-intervention-outcome pathway that transforms abstract behavioral science into concrete patient improvements, measurable health gains, and billable CCM/RPM touchpoints.

Cardiovascular

CHI: 70

Trigger: ↑ Weight + ↓ SpO₂ + ↑ HR (ΔCHI ≤ -5)

"Fluid changes may be affecting your heart. Log your weight within 2 hours and review your salt intake."

Target Compliance

85%+

Pulmonary

CHI: 65

Trigger: ↑ Respiratory Rate + ↑ Cough Frequency

"Your breathing pattern is changing. Try your prescribed inhaler routine now?"

Goal Response

<15min

Endocrine

CHI: 75

Trigger: No glucose logs for 48 hours

"You've tracked glucose 5 days straight — can we make it 7?"

Target Success

75%

🎯 IMPACT: Digital twin visual changes create emotional engagement without alert fatigue — transforming monitoring into billable behavioral interventions

Measurable Impact & ROI

Why This Matters

Healthcare innovation dies without proven ROI. Our comprehensive measurement framework tracks behavioral, clinical, operational, and financial metrics in real-time, targeting substantial returns through PMPM revenue optimization. This data-driven approach enables continuous optimization, evidence-based scaling, and alignment with value-based care contracts that reward outcomes over volume.

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Target +50%

Patient Engagement

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Goal -30%

30-Day Readmissions

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$100-180

PMPM Revenue

Continuous Optimization Metrics

Metric Layer	Key Measures	Target Performance
Engagement	Task completion, daily opens, response time	Target: +50% activation
Clinical	ΔCHI improvement, vitals stability	Goal: +8 CHI avg
Operational	CCM minutes logged, alerts resolved	Aim: 90%+ efficiency
Financial	PMPM revenue, ER visit reduction	Potential: $100-180 PMPM
Behavioral	Nudge response rate, adherence streaks	Target: 75% response

The Bottom Line

Every nudge is personalized, measurable, and billable — converting behavioral science into sustainable population health improvement through integrated CCM/RPM programs.

CCM & RPM Operational Integration

Why This Matters

CCM and RPM programs generate $100+ PMPM but suffer from 60% dropout rates due to passive monitoring. Our nudge-driven CHI system transforms these programs into active behavioral engines — every nudge becomes billable documentation, every patient response counts toward reimbursable minutes, creating a self-sustaining model where better engagement directly increases revenue.

Integrated Care Flow

1 Multi-Source Data Ingestion
RPM devices + Patient symptoms + Care team notes

2 CHI System Analysis
15 body systems evaluated with ΔCHI calculation

3 Intelligent Stratification
Tier 1: Auto-nudges | Tier 2: Hybrid | Tier 3: Escalation

4 Billable Actions Generated
Patient responses = RPM events | Follow-ups = CCM minutes

5 Automatic Documentation
CPT 99490/99439 (CCM) + 99457/99458 (RPM)

Program Performance

CCM Eligibility 2+ Chronic Conditions

Time Capture ≥20 min/month

RPM Requirement 16+ days/month

Auto-Documentation 100% Compliant

Reimbursement $100-180 PMPM

CCM + RPM Workflow Example: Heart Failure Patient

Event	Trigger	Nudge Action	Billable Outcome
Weight gain + ↓SpO₂	ΔCHI_cardio ≤ -4	"Check weight & O₂ now"	RPM event logged
No response 24h	Unresolved nudge	Care coordinator call	+15 CCM minutes
BP device offline	Data gap >48h	"Reconnect BP monitor"	RPM compliance
CHI rebounds +5	Improvement	"Heart score improving!"	Monthly summary

Financial Model & Sustainability

Why This Matters

Healthcare innovation requires sustainable economics. Our model creates a closed-loop reimbursement system where behavioral nudges generate billable touchpoints, documented minutes drive CPT codes, and improved outcomes unlock quality bonuses — turning patient engagement into predictable revenue streams while reducing costly readmissions.

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$100-180

PMPM per Patient

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5 CPT

Billable Codes

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Auto-Doc

100% Compliance

Revenue Streams & CPT Alignment

CCM Base (99490)

Mechanism: 20+ min/month care coordination
Nudge Role: Auto-logs patient interactions
Revenue: ~$65/month baseline

CCM Add-on (99439)

Mechanism: Additional 20 min increments
Nudge Role: Complex cases trigger follow-ups
Revenue: +$50/month when needed

RPM Device (99457)

Mechanism: 16+ days device data
Nudge Role: Ensures device compliance
Revenue: ~$55/month automated

RPM Interactive (99458)

Mechanism: 20+ min live interaction
Nudge Role: CHI alerts drive calls
Revenue: +$40/month when triggered

The Closed-Loop Economic Model

Data Ingestion → Behavioral Nudge → Patient Action → Auto-Documentation → Billable Claim → Revenue + Outcomes

Every nudge creates value: Better engagement → More billable minutes → Higher revenue → Improved outcomes → Quality bonuses

Financial Impact

Transform passive monitoring into active revenue generation — where every patient interaction becomes a billable event, every nudge drives documented care, and behavioral science creates sustainable healthcare economics.