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HEDIS depression measure movement
Follow up after positive screen. Response at six and twelve weeks. Remission tracking. The metrics CMS and NCQA already expect.
CogAI Medical for insurers
Move HEDIS. Before a member shows up in the ER.
Small and mid size plans use CogAI Medical to screen, stratify, and engage the members whose behavioral health trajectories are moving in the wrong direction. Validated instruments. Per-patient-per-month pricing. A real clinical operator on the pilot call.
What this moves
Four outcomes the plan already tracks
Outcome names, not numbers. Pilot targets are set against the plan's own baseline, not against a marketing figure.
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Reduced ER use linked to mental health
Early identification of high risk members supports proactive outreach. The downstream pattern is fewer crisis ER visits tied to anxiety, depression, and substance use.
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Reduced inpatient psychiatric admissions
Stratified panels let care management engage the members whose trend lines are moving in the wrong direction, before the event that lands them inpatient.
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Lower overall medical spend
Members with untreated behavioral health conditions consume more medical spend elsewhere. Identifying and engaging them reduces that downstream load.
Specific percentages are confirmed against the plan's own panel during pilot scoping.
Who this is for
Plans with a defined behavioral health problem
Medicare Advantage plans
Depression and anxiety screening on a monthly cadence. HEDIS movement across the panel. Identification of members whose trajectories suggest rising utilization.
Regional commercial plans
Member level deterioration detection for plans that want an early warning system on behavioral health without building one.
Workers compensation carriers
Behavioral health screening for members recovering from a work related injury. Anxiety, depression, PTSD, pain adjacent mental health, and sleep instruments appropriate to recovery are run on a cadence.
Self insured TPAs
Third party administrators serving self insured employer books. The same per patient per month model applies to the administered population.
Workers compensation
Recovery from a work related injury.
Mental health complications are the dominant driver of prolonged recovery after a work related injury. Untreated anxiety, depression, PTSD, and sleep disturbance extend time off, increase reinjury risk, and inflate claim cost.
CogAI Medical is not a pain management tool. It surfaces the mental health signal that drives the extended recovery curve.
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Screen at claim open
Validated instruments administered shortly after the claim opens. The baseline is set. The trend line has a start. - 02
Stratify by risk
The member panel is sorted by R-Score and by instrument flags. Claims with a rising trajectory are visible before the claim runs long. - 03
Route to care
Members above threshold are routed to the plan's behavioral health benefit or to Cognifica Health under BAA. - 04
Track recovery
Instruments run on a cadence through recovery. Response and remission are visible to the clinical team, not to the employer.
Pricing
Per patient per month
The rate is set during the pilot scoping call. Plan size, panel shape, and the instruments in scope drive the number.
$TBD / patient / month
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Per patient per month
Pricing is expressed per patient per month for the panel in scope. The rate is set during the pilot scoping conversation. - 02
Panel scope set up front
The plan defines the denominator. The pilot runs at that scope. Expansion happens on renewal, not mid pilot. - 03
No individual level data flows to the plan
Aggregate HEDIS movement and panel level trend report to the plan. Individual member records remain with the clinical entity under BAA.
What we are usually asked
Objections, answered
Our care management team already does this.
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Care management typically engages members after a claim signals a problem. CogAI Medical engages before. Validated instruments on a monthly cadence surface members whose trajectories are shifting, and deliver them into care management with a composite score and a visible trend.
We already have a behavioral health vendor.
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Behavioral health vendors typically deliver care. CogAI Medical identifies. The two sit together, not on top of each other. For plans without a clinical delivery arm, Cognifica Health is available for delivery under BAA.
We are not set up for a new clinical workflow.
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The only role that resolves identity at the individual level is the Medical Provider role. Plan-side users see aggregate and HEDIS movement. The clinical workflow runs in the Cognifica boundary.
What about downside pressure on premiums?
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Per patient per month pricing is set against projected claim offset. For plans with documented ER and inpatient pressure on behavioral health, the pilot is structured to surface the offset inside six months.
How do you handle privacy and HIPAA?
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Cognifica signs a BAA with every plan. Member consent is captured up front, revocable, and timestamped. Aggregate and HEDIS reporting flow to the plan. Individual identity does not, absent explicit member consent in a clinical context.
Why would a small plan buy this instead of a larger vendor?
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Small plans need a real operator on the line, not a sales team. The clinical team is on the pilot call. The founder is on the pilot call. The rollout is fast, and the commitment is measured on one HEDIS cycle.
Book a call
Scope a pilot against your own panel.
A clinical operator and the founder are on the call. We look at the panel shape, the HEDIS measures in scope, and the timeline. Forty-five minutes.
- Panel scoping
- HEDIS measures in scope
- Per patient per month proposal