The platform that makes a small care team act like a big one.
HealthQuilt is the AI-assisted care coordination software behind every CareAtlas program. It documents the visit you didn't have time to chart. It surfaces the patient you didn't have time to call. It prepares your navigators for the conversation before they dial. Built for the team you already have.
Three jobs. One platform. Every patient accounted for.
HealthQuilt handles the coordination work that makes Medicare care management actually pencil out. Your team stops fighting the tools. Patients get more of the human attention they came for.
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AI-drafted documentation that clinicians actually sign
HealthQuilt drafts the note while the navigator has the conversation. SOAP notes, SBAR updates, care-plan revisions, TCM medication reconciliations — drafted from the call itself and the patient's longitudinal record, then routed to a clinician for review and signature. Most drafts are signed without edits. The ones that aren't teach the system.
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Care-gap surfacing at the top of the day
Every morning, HealthQuilt tells each navigator which three patients need them most — ranked by clinical risk, program-compliance status, and days-since-last-touch. Not a list of 80. A short list of three. The patients who fall through the cracks in most programs are the ones who stay visible in this one.
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Billing and compliance without a billing specialist
Every time-tracked minute, every qualifying touch, every required element of a CCM / TCM / APCM encounter is logged structurally as it happens. Month-end is not a reconciliation project — it's a report. Hospitals bill through CareAtlas's affiliated professional corporation. Practices export clean, scrubbed claims into their existing RCM.
Five layers. One coordinated system of record.
HealthQuilt is not a chat interface on top of an EHR. It is a purpose-built platform for care management — data, orchestration, documentation, integrations, and compliance in a single system that was designed for this work, not retrofitted to it.
Every patient, fully assembled.
HealthQuilt pulls from your EHR, from HIE and Metriport exchanges, from device streams, and from every navigator touch — then assembles a unified longitudinal record. Medication history. Diagnoses and problem lists. Vitals trends over months, not snapshots. SDOH context captured by a human who asked. The proprietary touch-level data is where the moat lives.
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AI that prepares the human, then gets out of the way.
HealthQuilt runs purpose-specific AI agents behind the scenes — a pre-call briefing agent, a documentation agent, an RPM triage agent, a care-gap agent, a claim-narrative agent. Each agent does one thing well. None of them talk to the patient. All of them make the human on the call better-prepared than they could be alone.
The right touch, by the right person, at the right time
HealthQuilt orchestrates thousands of touches across hundreds of patients — assigning each one to the navigator or clinician whose license, certification, and workload match. Monthly CCM outreach. 48-hour TCM follow-up. Triage of a high-BP RPM reading. An APCM care-plan refresh. The platform routes it — the human delivers it.
Lives inside the workflow the physician already has.
HealthQuilt integrates directly with athenahealth (pilot), Canvas, and Epic Community Connect. Other EHRs connect through industry-standard integration layers. Physicians see CareAtlas insights inside their existing workflow — no separate login, no context switching, no new IT project.
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Every required element, captured as it happens
Time tracking by CPT code. Required care-plan elements for CCM. Medication reconciliation timestamps for TCM. Risk-tier attribution for APCM. Consent capture. Audit logs. Everything Medicare asks for at claim time is captured structurally during the work — not reconstructed afterward. Clean claims. Fewer denials. No paper-chase.
One platform. Real navigators. Monthly cadence that actually holds.
The reason most CCM programs underperform is not the code set — it's that the monthly cadence collapses under workload. CareAtlas holds the cadence by doing the coordination work outside your staff's queue.
Built for the hundred small things that make care management work.
Every feature in HealthQuilt exists because a navigator, clinician, or billing lead said "the thing that breaks this program is…" — and we built the specific fix. No feature theater. No dashboards nobody opens.
Pre-call briefing
Your patients get a dedicated care navigator who knows their name, calls them regularly, and helps them manage their conditions. Not a chatbot. Not an app. A person.
AI-drafted clinical
documentation
SOAP notes, SBAR updates, TCM med-rec drafts, APCM care-plan refreshes. Drafted, not written. Reviewed and signed by the licensed clinician.
RPM triage
Incoming device readings are triaged continuously. Transient single-value outliers get acknowledged — sustained deterioration gets escalated to a clinical navigator in real time.
Pre-call briefing
Your patients get a dedicated care navigator who knows their name, calls them regularly, and helps them manage their conditions. Not a chatbot. Not an app. A person.
Consent and eligibility
capture
Structured consent recording and Medicare eligibility checks at enrollment — no paperwork backlog.
Claim narrative assembly
Every billable service ships with a narrative sufficient for audit — generated from the touch record, not retyped at month-end.
Longitudinal chart
One continuous record per patient across programs, care transitions, and years. No episode silos. No reconstruction.
AI-drafted clinical
documentation
SOAP notes, SBAR updates, TCM med-rec drafts, APCM care-plan refreshes. Drafted, not written. Reviewed and signed by the licensed clinician.
Built to work inside the EHR you already run.
HealthQuilt is not a replacement system. It connects to your EHR, pulls chart data on ingest, and pushes structured clinical summaries back — so your physicians see the CareAtlas work inside the workflow they already trust. We use direct integrations where the EHR supports them and industry-standard integration layers for the rest.
Patient data handled the way a patient would want it handled.
HIPAA-compliant from the ground up. Every integration runs under a signed BAA. Every access to a patient's record is logged. Every care team member — human or AI agent — operates with the permissions their license, certification, and role allow.
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HIPAA Security Rule compliance
CareAtlas is provider of record — your hospital pays nothing. We manage RPM, CCM, TCM, and APCM across service lines, reduce readmissions, and generate net-new Medicare revenue with zero cost, zero FTEs, and zero risk.
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Business Associate Agreements
With every partner organization, every integration vendor, and every sub-processor touching PHI.
Role-based access control
Navigators, clinicians, billing staff, and partner users each see only what their role and license require. AI agents operate under the same permission model — not a bypass.
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Audit trail
every chart access, every touch, every AI-generated draft, and every clinician override is logged and attributable.
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SOC 2
Type I in place; Type II in progress. Documentation available under NDA.
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Affiliated professional corporation
For hospital partnerships, CareAtlas serves as provider of record through a corporate-practice-of-medicine compliant professional corporation. Legal structure and state licensure posture available during diligence.
One platform. Four Medicare programs.
HealthQuilt is the operating system behind every CareAtlas program. Same platform. Same team. Four distinct revenue and clinical models — run end-to-end.
Remote Patient Monitoring
RPM: Daily visibility into patient health
Cellular-connected devices ship directly to patients — blood pressure cuffs, glucose monitors, pulse oximeters, scales. No WiFi. No smartphone. No patient app. Daily readings are monitored by dedicated care navigators with AI-assisted alerts that catch deterioration before it becomes an ER visit.
