Every domain of population health.
One unified AI platform.

AI scans every attributed patient daily across 245+ measures, surfacing open gaps with priority scoring and recommended next actions — before payer deadlines, not after.

Live composite quality scores by payer, measure set, and individual provider — updated continuously from EMR and claims data, always current.

Auto-generated daily lists of patients due for specific measures, ranked by clinical impact and payer deadline proximity — ready for your care team each morning.

Monitor UDS reporting progress, CMS Star ratings, and NCQA accreditation metrics from a single unified view — with trend lines showing trajectory toward annual targets.

Threshold alerts when quality scores approach contract penalty zones, with AI-recommended patient-level interventions to recover performance before the deadline.

Continuously scores every patient by clinical, social, and utilization risk — automatically surfacing the highest-need individuals for immediate care team action, every single day.

AI generates, updates, and tracks individualized care plans — flagging overdue interventions and recommending next actions for each patient, keeping your care team one step ahead.

Tracks CCM-eligible patients, logs care minutes automatically, and generates documentation to support accurate, complete billing — helping document care that may be reimbursable, subject to applicable rules.

Monitors hospital discharges and ER visits in real time, triggering automated follow-up workflows within required 7- and 30-day windows to prevent costly readmissions.

AI schedules and executes personalized outreach via phone, SMS, and portal — prioritizing contacts by health risk and ensuring no high-needs patient is overlooked between visits.

Before every appointment, Unity auto-generates a patient-specific briefing: open care gaps, due preventive services, HCC coding opportunities, and recommended actions — delivered to the provider before they walk in.

Identifies all AWV-eligible patients, auto-schedules outreach, tracks completion rates by provider and payer, and flags uncompleted AWVs — maximizing this high-value Medicare benefit.

AI predicts no-show risk for every scheduled patient using historical patterns, SDoH factors, and engagement signals — triggering automated reminders and overbooking recommendations.

Surfaces HCC coding opportunities, quality measure closures, and additional clinical services for each visit — ensuring providers capture the full clinical and quality value of every encounter.

After each visit, AI automatically creates follow-up tasks, referral tracking, lab result review queues, and patient outreach — closing the loop without requiring staff intervention.

AI continuously monitors referral patterns and flags out-of-network utilization — alerting care teams before high-cost encounters occur and recommending preferred in-network alternatives.

Every referral tracked from creation to completion — automatically following up on pending consults, capturing results, and ensuring no referral falls through the cracks.

Scores every specialist and facility in your network by cost, quality, outcomes, and patient satisfaction — surfacing top performers and flagging high-cost outliers.

Full visibility into referral volumes, specialty distribution, cost per episode, and utilization trends — enabling data-driven decisions about network composition and care pathways.

AI recommends highest-value in-network providers at the point of referral — reducing out-of-network costs and protecting shared-savings performance before the episode occurs.

All payer contracts — MSSP, Medicare Advantage, and commercial VBC — in one real-time view showing current performance vs. thresholds, bonus potential, and penalty risk for every agreement.

AI monitors every contract metric continuously and alerts care teams 48–72 hours before a threshold breach — with specific patient-level interventions to recover performance before the deadline.

Real-time shared-savings calculations for every MSSP and VBC contract — projecting year-end distributions and showing exactly which interventions will maximize your reconciliation check.

Side-by-side performance scorecards for every payer — comparing your quality, utilization, and performance metrics against contract targets and peer benchmarks.

AI analyzes historical performance data to identify your strongest contract terms, flag unfavorable provisions, and generate data-driven recommendations for renewal negotiations.

AI reviews clinical data, claims history, and pharmacy records to identify undocumented HCC diagnoses — surfacing specific patients and conditions before each visit so providers can address them at the point of care.

Real-time RAF score tracking for every Medicare Advantage and VBC patient — projecting year-end risk-adjusted accuracy and identifying highest-impact actions before payer submission deadlines.

Automated retrospective chart reviews identify missed HCC opportunities from prior periods — flagging addendums, correcting undercoding, and generating compliant documentation for resubmission.

Continuously validates HCC documentation against CMS RADV audit standards — ensuring every coded diagnosis is supported by compliant clinical documentation before CMS review.

Scores every attributed patient by predicted risk trajectory — identifying patients likely to increase in complexity and enabling proactive interventions before costly acute episodes occur.

Unity contacts every patient via their preferred channel — SMS, automated phone, secure portal message, or email — with AI-personalized messaging based on health needs, language, and engagement history.

AI launches targeted campaigns for every open care gap — AWV scheduling, preventive screenings, chronic care follow-ups, and immunizations — tracking responses and escalating non-responders automatically.

Automated multi-touch reminders sent 7 days, 48 hours, and 2 hours before each visit — with one-click rescheduling and AI prediction of no-show risk for proactive intervention.

Automated post-visit surveys, follow-up instructions, and care plan reminders — reinforcing clinical recommendations and capturing patient satisfaction scores without staff intervention.

Real-time dashboards tracking outreach delivery, open rates, response rates, and care gap closure by channel, campaign, population segment, and individual provider.

FDA-cleared devices — BP cuffs, glucometers, weight scales, pulse oximeters — provisioned and shipped directly to enrolled patients. Device supply may be reimbursable, subject to payer rules.

Unity identifies eligible patients in your EMR, obtains consent, handles device setup and patient training — everything from first touch to active monitoring without burdening your staff.

Every vital reading analyzed against patient-specific thresholds — generating care team alerts, EMR tasks, and escalations for abnormal values, fulfilling CMS monthly management requirements.

Unity automatically tracks device supply days, transmission counts, and monthly management minutes — generating documentation to support accurate, complete billing for reimbursable monitoring programs, subject to payer rules.

Early detection of deterioration prevents costly hospitalizations — documented 38% reduction in preventable ER visits for enrolled RPM patients, improving outcomes while reducing total cost of care.