Turn care gaps into completed care.
VascAI reviews discharge summaries, claims, care gap reports and visit notes, then builds a task list for each patient. Routine tasks are completed automatically. Tasks that need a person go to our field team and clinicians.
Use Cases
Transitions of care
Fewer Readmissions After Discharge
When a member leaves the hospital, we carry out the discharge plan, from the first call to the follow-up visit at home or by video.
Program capabilities
- Outreach within days of discharge
- Medication review with our pharmacist
- Home or video follow-up visit
- Updates to the plan and primary care provider
Proactive outreach
Maria G.
Care team
Check-in call completed
Field team
Follow-up visit booked
Scheduled
Transportation arranged
Confirmed
Medication support
David K.
Pharmacist
Medication gap identified
Flagged
Pharmacist review completed
Resolved
Update sent to PCP and plan
Delivered
Care coordination
Automate Scheduling and Care Coordination
Agents handle referrals and scheduling automatically, so your coordinators can focus on the patients who need a person.
Program capabilities
- Appointments booked and rescheduled automatically
- Specialist and community referrals tracked to completion
- Text and phone reminders before every visit
- Updates sent to coordinators and the PCP
Auto scheduling
Linda P.
Agent
Follow-up appointment booked
Scheduled
Ride to appointment arranged
Confirmed
Reminder sent by text
Delivered
Referral coordination
Robert M.
Agent
New referral received
Flagged
Specialist appointment booked
Booked
Care team updated
Delivered
Quality and HEDIS gaps
Close Quality Gaps in One Field Visit
Agents find members with open gaps and book the visit. A certified field worker then closes several gaps in one home or video visit.
Program capabilities
- Open gaps found across your member list
- Visits booked automatically
- Lab draws and screenings at home
- Coded documentation for HEDIS reporting
Gap identification
Member list
Prioritized
Members with open gaps found
Prioritized
Gaps grouped into one visit
Queued
Home visits booked
Scheduled
Field visit deployed
James T.
Field team
Field worker on the way
Dispatched
A1c drawn at home
Completed
Gaps closed and coded
Closed
Medicaid redetermination
Keep Members Covered at Renewal
We reach members before their Medicaid renewal date and help them complete the paperwork, so their care is not interrupted.
Program capabilities
- Renewal dates tracked across your member list
- Outreach by text and phone, with home visits when needed
- Help completing renewal forms
- Status updates sent back to the plan
Renewal tracking
Rosa L.
Agent
Renewal date identified
Flagged
Outreach text sent
Delivered
Call booked with member
Booked
Renewal support
Ahmed S.
Field team
Home visit to help with forms
Completed
Documents collected
Completed
Renewal submitted
Submitted
Enhanced Care Management (ECM)
Deliver ECM With a Local Care Team
We deliver Medi-Cal Enhanced Care Management with certified field workers, while our agents handle outreach and documentation.
Program capabilities
- Outreach and enrollment for eligible members
- Care plans built with each member
- Regular check-ins at home or by video
- Documentation and billing support for ECM
Member enrollment
Carlos R.
Agent
Eligibility confirmed
Verified
Outreach call completed
Reached
Member enrolled in ECM
Enrolled
Ongoing care management
Grace N.
Field team
Monthly home check-in
Completed
Housing support referral
Referred
Care plan updated
Updated
One data orchestration layer for health plans and providers,
so care gets delivered faster and with less work.
Use the software with your own staff, or add our field team for the full stack. Either way, it runs on one platform.
Ways to work with us
We fit into how your organization already works, from paying for care to delivering it in the community.
Health plans
Share members with open gaps or recent discharges. We complete the outreach and visits, with pricing that fits your contract.
Hospitals and IPAs
We follow up after discharge and close care gaps for your patients, then send visit notes and results back to your team.
FQHCs
Use our software with your own CHWs to scale your programs. Agents handle scheduling and documentation, and results go back to your EHR.
Community-based organizations
Use our software to scale your community programs. Your CHWs document visits and get paid for the work they already do, while agents handle the paperwork.
See how VascAI fits your population.
Tell us where follow-up is slipping, and we'll walk you through it.