Agentic AI  ·  Population Health  ·  Value-Based Care

The AI Agent That Works
While You Care.

Unity PHM is the enterprise-grade Agentic AI platform that continuously closes care gaps, optimizes clinical performance, and improves value-based care performance — for health centers, ACOs, health systems, and payers.

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One Connected System

Close a gap in one domain.
Unity closes them all.

Clinical, operational, and financial performance aren't three separate problems — they're one connected loop. A gap in any one quietly drags down the other two. Unity's AI agent works all three at once, so every action compounds instead of stalling.

In practice — one action, three wins

Op Optimize a visit Clin Care gap closes Fin Quality score & shared savings rise

One action ripples through all three domains — that's the compounding loop.

Eight Integrated Modules

Every domain of population health. One unified platform.

Unity's eight purpose-built modules work together as a single AI engine — not a collection of disconnected tools. Each module shares data, triggers actions, and informs the others.

HEDIS · Star Ratings · NCQA

Quality Management

AI scans 245+ measures daily, ranks patients by priority, and auto-generates outreach — lifting quality scores and capturing payer performance bonuses.

+17%
Avg Score Lift
87%
Gap Closure

Risk Stratification · CCM · Care Plans

Care Management

Continuously scores every patient by clinical and social risk, auto-generates care plans, tracks CCM billing, and ensures no high-risk patient falls through the cracks.

More Patients Reached
+$180K
CCM Value/Year

Pre-Visit Prep · AWV · No-Show AI

Visit Management

Maximizes the clinical and quality value of every encounter — AI pre-visit briefs, AWV optimization, no-show prediction, and post-visit follow-up automation.

+26%
Value Per Visit
−34%
No-Shows

Referral Tracking · Leakage Prevention

Network Management

Keeps patients in-network, tracks every referral from creation to closure, and flags out-of-network utilization before it drains your shared-savings performance.

−42%
Network Leakage
+$220K
Shared Savings

MSSP · Medicare Advantage · VBC

Contract Management

Real-time visibility into every payer contract — performance vs. thresholds, shared savings projections, and 48-hour early warnings before a breach costs you bonus dollars.

+$350K
Shared Savings
48hr
Early Warning

HCC Coding · RAF Optimization

Risk Management

Identifies undocumented HCC diagnoses, improves RAF scores, and supports complete, accurate risk-adjustment documentation — with 98% RADV audit readiness built in.

+17%
RAF Score Lift
+$300K
Risk Adj. Value

AI Outreach · SMS · Voice · Portal

Patient Engagement

Reaches every attributed patient via their preferred channel with AI-personalized messaging — achieving 68% response rates and reducing staff outreach burden by 80%.

3.4×
Patients Reached
68%
Response Rate

RPM · Devices Included · AI Billing

Remote Monitoring

A fully managed RPM program with devices shipped to patients, 24/7 AI monitoring, and automated billing support — supporting documentation for reimbursable monitoring programs, subject to payer rules.

$142K+
New Value/100 Pts
$0
Patient Cost
The Challenge

Healthcare organizations are missing measurable opportunities to improve outcomes — every year.

The gap isn't clinical intent. It's operational capacity. Your team can't manually track thousands of patients, manage every payer contract, and close every care gap — and traditional PHM tools only report the problem.

Care Gaps Go Unclosed

HEDIS measures plateau because staff lack the bandwidth to work every patient list. Preventable gaps persist — costing quality bonuses, Star ratings, and shared savings dollars.

Outcomes Left on the Table

Attribution mismatches, undocumented HCC codes, missed AWVs, and unmonitored payer thresholds quietly drain six- and seven-figure VBC opportunities each year.

Staff Time Overwhelmed

Care coordinators spend 100+ hours a week on manual outreach, list-building, and report generation — work that AI can handle automatically, freeing your team for patients who need them.

How Unity Works

Most platforms give you a dashboard.
Unity gives you a finished day.

Unity's AI Agent doesn't just surface care gaps — it closes them. It creates EMR tasks, places orders, messages patients, schedules appointments, reconciles attribution, and submits payer data. Every day. Automatically.

Ingest

Continuously pulls data from your EMR, PM system, payer attribution files, HIE, and patient registries — creating a unified, real-time view of every attributed patient.

Stratify

Scores every patient by clinical risk, care gap priority, HCC coding opportunity, and payer contract deadline — so the right patients get the right attention at the right time.

Act

Automatically creates EMR tasks, places lab and imaging orders, sends personalized patient outreach, uploads clinical documents, and monitors payer performance thresholds — no manual work required.

Deliver

Closed care gaps, filled schedules, improved outcomes, protected contracts, and improved quality scores — all visible in real-time dashboards with full audit trails.

Proven ROI

Measurable clinical and quality impact within 90 days.

Based on a 10-provider, 12,000-patient clinic with MSSP, Medicare Advantage, and commercial VBC contracts.

Before Unity

Metric Before Unity After Unity
Quality Score 68% 85% ↑ +17pts
Care Gaps Closed 58% 87% ↑ +29pts
AWV Completion 62% 88% ↑ +26pts
RAF Score Accuracy 75% 92% ↑ +17pts
Shared Savings $250K $900K ↑ 3.6×
$900K
Annual VBC Value Gain
$109K
Annual Labor Savings
$1M+
Total Annual Impact
70%
Reduction in Manual Effort

"Unity's AI Agent handled what would have taken five full-time coordinators — and did it better. We saw our first closed care gaps in the EMR within two weeks of going live."

CH
Chief Operating Officer
Community Health Center, Ohio
Why Unity

Built differently. Designed for outcomes.

Unity isn't just another PHM dashboard. It's an AI agent that takes action on behalf of your care team — purpose-built for the operational realities of healthcare delivery.

Agentic, Not Analytic

Unity takes action — it doesn't just report. EMR tasks, lab orders, patient messages, payer submissions — all executed autonomously while your team focuses on care delivery.

Works With Your EMR

FHIR-based integrations with major EMRs including Epic, eClinicalWorks, athenahealth, Veradigm, and dr.chrono. No rip-and-replace, no complex implementation — live in weeks, not years.

No Added Headcount

Scale your population health programs without adding staff. Unity's AI agent covers 100% of your attributed patient population, every day — appointments or not.

Enterprise-Grade Security

Built for HIPAA, aligned with SOC 2-type controls, FHIR R4 ready, HL7 integrated. Every AI action is logged in a full audit trail — giving your compliance team complete transparency.

ROI in 90 Days

Flexible contract terms and a 3-month no-obligation trial. Most clinics identify their first measurable improvement opportunity within the first week of access.

Healthcare-Native Design

Built exclusively for healthcare — UDS reporting, HRSA requirements, sliding-fee context, payer attribution logic, and HEDIS workflows are built-in, not bolted on.

See Unity in Your EMR in
20 Minutes.

We'll walk you through a live demo using your specialty mix and patient population. No prep required. No commitment necessary.

Built for HIPAA  ·  Aligned with SOC 2-type controls  ·  FHIR R4 Ready  ·  HL7 Integrated  ·  Dublin, OH