You have the staff, the data, and the clinical programs. The gap is execution at the scale of a health system attribution — post-discharge follow-up that misses the highest-risk patients, after-hours calls that default to the ED, HCC documentation that closes short of year-end targets, and prior auth backlogs that delay care for patients already scheduled.
Request a DemoHealth systems managing large attributed populations face the same structural problem across every care management program: the analytics layer identifies who needs attention. The execution infrastructure cannot keep up with the volume of acting on it.
CMS requires contact within 24–48 hours and a follow-up visit within 7–14 days for TCM billing. At health system scale, manual outreach consistently misses a significant share of eligible patients — often the highest-risk ones, the most likely to return to the ED.
Patients calling after hours frequently reach voicemail or answering services that cannot triage clinically. Non-urgent ED visits increase. On-call physicians field routine calls. HCAHPS scores reflect the access gap, and shared savings take the hit.
Analytics identify every underdocumented condition and quality measure gap. Closing them before year-end requires outreach, scheduling, visit completion, and documentation alignment that coordinator capacity cannot sustain at health system ACO scale.
High-volume specialty services — orthopedics, cardiology, oncology, imaging — process thousands of prior authorizations monthly. Manual submission, tracking, and denial management consumes significant administrative FTE and delays care for patients already in the system.
Zynix AI is an execution layer that sits between your care management programs and your patient population. It carries the contact volume, documentation, and coordination work that your team identifies but cannot sustain at health system scale.
Every discharged patient contacted. Every chronic care touchpoint documented. Every quality gap outreach triggered and tracked through to completion. Coordinators receive escalations and exceptions — not a list of calls to make from scratch.
Evidence-based triage handles routine after-hours calls in 15+ languages, schedules next-day access, and surfaces only genuine clinical escalations. Consistent coverage across every site without additional on-call burden.
Gaps prioritized by RAF impact and closure window. Outreach, scheduling, and documentation alignment run in sequence. The platform tracks completion, not just identification — so year-end performance reflects work that actually got done.
Documentation assembly, prior auth submission, denial routing, fax classification, and referral coordination run without coordinator involvement at every step. Clinical staff spend their time on patients who need a human.
Use Cases
Reaching every discharged patient within 24-48 hours, consistently, at health system volume, with TCM billing documentation captured in parallel.
View use case →Clinical triage at every site after hours, without routing routine calls to on-call physicians or losing patients to non-urgent ED visits.
View use case →Closing HCC documentation and quality measure gaps before year-end through coordinated outreach and scheduling, not raw gap lists.
View use case →Automated documentation assembly, payer submission, tracking, and denial management for thousands of monthly prior auths in orthopedics, cardiology, oncology, and imaging.
View use case →Structured clinical notes from every patient visit, uploaded directly to the EHR, without adding documentation time after the encounter.
View use case →Platform
Manages every post-discharge step from ADT trigger to 30-day close. Medication reconciliation, symptom assessment, TCM visit scheduling, and billing documentation, one closed-loop workflow.
24/7 clinical triage across all health system sites. Evidence-based triage logic, 15+ languages, EHR-integrated. Escalates only when escalation is clinically warranted.
Post-Discharge TCM, HCC + Quality Gap Closure Sprint, Prior Auth Acceleration. Orchestrated multi-agent programs that run from trigger to outcome.
Ambient AI scribing that captures the patient-clinician conversation and produces structured clinical notes uploaded directly to the EHR.
Fewer than 30% of eligible patients are reached within the 24-48 hour post-discharge window when outreach relies on manual coordinator workflows.
The gap widens at health system volume, higher throughput, stretched teams, and inconsistent ADT notification across sites compound the shortfall.
Health system ACOs capturing full TCM reimbursement maintain measurably higher post-discharge visit completion rates than those relying on manual outreach.
TCM billing eligibility and post-discharge contact quality are closely correlated, systems that reach more patients also bill more completely.
Physicians in large health systems report spending significant administrative time weekly on prior authorization submission, status tracking, and denial management.
High-volume specialty services bear a disproportionate share, orthopedics, cardiology, and oncology consistently top prior auth volume rankings.
Top-quartile health system ACOs outperform bottom-quartile peers on post-discharge contact rates and HCC closure rates by a measurable and consistent margin.
The spread is not explained by panel size or patient complexity alone, operational execution quality is the differentiating variable.
NAACOS ACO Benchmarking Data
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