Your AI documentation copilot optimizes what your contracts pay for.
Move the inputs to see what that means for your panel.
Panel size
10,000
Diagnosis share
65%
Other or acute only
35%
Scenario inputs
Modeled estimates: Dollar figures, audit-risk scores, patient outcome scores, and archetype mixes are scaled or modeled. They are not verified CMS values unless the source note says so.
Fee-for-service
FFS pays for billable visits and services.
What the AI surfaces
Document one additional chronic problem managed to support 99215 when defensible.
Add diabetic foot exam G0245 if the exam was performed.
Capture care-coordination time to support G2211 when rules are met.
What that drives
Visit-level coding lift, more documentation per encounter, and a stronger push to turn work already done into billable evidence.
Revenue and riskmodeled estimate
$249,600 modeled annual lift by Year 3 for 4,000 FFS lives. Audit risk moves from low to medium if visit coding becomes an outlier.
Patient consequence
Longer encounters and possible cost-sharing increase. Chronic disease control does not improve unless clinical work changes.
Medicare Shared Savings Program
MSSP is Medicare's accountable-care shared-savings program.
What the AI surfaces
BP averaged 148/92 over 3 visits. Suggest titration and pharmacist consult.
HbA1c is 9.2 with no endocrinology referral. Suggest care management enrollment.
Two missed follow-ups. Suggest community health worker outreach this week.
What that drives
Care management intensification for high-risk patients, outreach after missed visits, medication titration, and referral closure.
Revenue and riskmodeled estimate
$525,000 modeled Year 3 shared-savings opportunity for 2,500 MSSP lives if quality gates clear. Year 1 is usually an investment year.
Patient consequence
Better chronic disease control by Year 2 and Year 3, with fewer avoidable ED visits and hospitalizations if execution holds.
Medicare Advantage risk adjustment
HCC and RAF are Medicare Advantage risk-adjustment inputs.
What the AI surfaces
If eGFR is under 60, consider E11.22 for diabetes with chronic kidney disease.
If DSM-5 criteria are met, document F33.1 for recurrent moderate major depressive disorder.
Document old myocardial infarction I25.2 annually when supported by the record.
What that drives
HCC capture intensification, annual wellness visits built around recoding, and coder review inside the clinical workflow.
Revenue and riskmodeled estimate
$2,262,000 modeled Year 3 RAF lift for 2,000 MA lives. Audit risk is high if documentation outpaces medical-record support.
Patient consequence
The chart looks sicker. Care may be unchanged. Population health appearance can move without population health reality moving.
Employer self-insured or direct
PEPM means per employee per month.
What the AI surfaces
No app open in 14 days. Schedule outreach to protect engagement KPI.
Wellness coaching session completed. Flag for the monthly employer report.
Document time in care to support utilization billing.
What that drives
Touchpoint frequency, engagement reporting, and defensible utilization. Clinical improvement depends on what the employer contract pays for.
Revenue and riskmodeled estimate
$270,000 modeled annual revenue at $15 modeled PEPM for 1,500 covered lives. Renewal risk rises if the CFO sees engagement without cost reduction.
Patient consequence
More messages, nudges, and coaching touches. Outcome gains are weaker unless the contract pays for measurable control or utilization change.
Same AI. Same panel. Same diagnoses. Four different companies you become.
Three-year projection
The Year 1 choice compounds into a different operating model by Year 3. Dollar figures and audit-risk scores are modeled estimates.