Identify Every High-Risk Patient. Before the Emergency Room Does.
Zabrizon's AI population health platform uses machine learning to stratify risk, close quality gaps, and drive proactive outreach — turning your attributed population into a high-performing asset for value-based contracts.
Why Providers Struggle to Succeed in Value-Based Care
Population health success requires identifying and acting on risk before it becomes cost — and most provider organisations lack the AI infrastructure to do so at scale.
Reactive vs. Preventive Care
Without predictive risk models, providers intervene only when patients present — the most expensive and least effective point. High-risk patients need identification months before their next crisis.
Quality Measure Gaps
HEDIS, Stars, and CMS quality measures drive VBC revenue, but manual gap identification across thousands of patients is impossible at scale. AI closes gaps 5× faster than traditional workflows.
Social Determinants of Health
50–80% of health outcomes are driven by social factors — food insecurity, housing instability, transportation — but most EHR systems capture less than 10% of SDOH data at the population level.
VBC Contract Performance Visibility
ACO and bundled payment performance is measured annually — but by the time results arrive, the performance period is over. Real-time analytics are essential for mid-year course correction.
Population Health AI Capabilities
Proactive, data-driven population health management from risk identification to outcome measurement.
AI Risk Stratification & Predictive Analytics
Learn moreMachine learning models analyse clinical, claims, lab, pharmacy, and SDOH data to assign dynamic risk scores and predict high-cost utilisation events 30–90 days in advance.
- 50+ clinical, claims, and social risk factors per patient
- Condition-specific models: CHF, COPD, diabetes, CKD, readmission
- Monthly risk score refresh with trend indicators
- Risk cohort segmentation for care management prioritisation
Quality Measure & HEDIS Gap Closure
Learn moreAutomated identification and workflow activation for every open HEDIS, CMS Stars, and payer quality measure gap across your attributed population.
- Real-time quality gap dashboard across 60+ HEDIS measures
- Automated patient outreach for screenings, follow-ups, and labs
- Point-of-care gap alerts surfaced in EHR workflow
- Quality measure performance projection vs. benchmark
SDOH Screening & Navigation
Learn moreSystematic social determinants of health screening integrated into clinical workflows — with automated referrals to community-based organisations and SDOH intervention tracking.
- SDOH screeners (AHC-HRSN, PRAPARE) in patient portal and kiosk
- Automated community resource referral by need type
- SDOH data captured in structured EHR format
- Intervention effectiveness tracking and ROI reporting
Integrates with your existing systems
Works With Every Major EHR Platform
HL7 FHIR R4 native • SMART on FHIR • REST APIs • Custom HL7 v2 connectors
Ready to Succeed in Value-Based Care with AI Population Health?
See how Zabrizon's AI population health platform can improve your HEDIS scores and reduce total cost of care within 12 months.