April 6, 2026
By Jay Chowdappa, MD, co-founder and CEO, Zynix AI · Updated October 1, 2026
AI transforms value-based care by connecting three jobs that usually sit in separate tools: finding high-risk and rising-risk patients, closing care gaps before year-end, and documenting the work. Population health analytics rank who needs attention, AI agents run outreach and scheduling within care-team rules, and clinicians keep every clinical decision.
The shift from fee-for-service to value-based care is accelerating across the US healthcare system. CMS has set a goal for all people with Traditional Medicare to be in a care relationship with accountability for quality and total cost of care by 2030, and commercial payers are rapidly expanding risk-based contracts. For health systems, ACOs, and provider groups, success in value-based care depends on three capabilities: identifying high-risk patients before adverse events, closing care gaps proactively, and demonstrating measurable quality outcomes.
AI is emerging as the critical enabler of these capabilities—but most AI solutions address only one piece of the puzzle. Zynix AI takes a fundamentally different approach: the Zynix platform connects population health, risk stratification, care gap closure, and clinical documentation in one place.
Traditional population health platforms provide dashboards and reports. Zynix AI goes further with AI agents that take action—running outreach, scheduling and reminders within the rules your team sets—not just surface insights.
Zynix AI's care gap identification continuously analyzes patient data across claims, EHR records, and health information exchanges to identify open care gaps—preventive screenings, chronic disease management milestones, and quality measure compliance. Unlike passive alerting systems, it triggers automated outreach workflows to schedule patients for needed services, reducing the manual effort required by care coordinators.
Zynix AI's risk stratification uses machine learning models trained on clinical, claims, and social determinant data to stratify patient populations by risk level. Health systems can identify patients at highest risk for hospital readmission, emergency department utilization, or chronic disease progression—enabling proactive interventions before costly acute events occur.
Key capabilities include:
Health systems often evaluate Zynix AI alongside Epic's Healthy Planet, Oracle Health's population health modules, and Innovaccer's Data Activation Platform. Here's how they compare:
Epic's population health module, Healthy Planet, is part of the Epic ecosystem and is used for care coordination and value-based analytics. It suits organizations that run Epic and want population health work to stay inside their Epic environment.
Oracle Health offers population health software that unifies data from disparate sources into longitudinal records for individuals and populations, with care management, contract management and analytics. It suits organizations that want population health tools from their EHR vendor, particularly those already running Oracle Health.
Innovaccer's Data Activation Platform focuses on data unification and analytics for value-based care organizations. Innovaccer also markets AI agents, which it calls Agents of Care, and ambient documentation. It suits organizations that want a broad data and analytics platform with agents from the same vendor.
Zynix AI suits organizations that want analytics and the follow-up work in one place, across whichever EHRs their practices run. Analytics rank the patients who need attention, AI agents such as ZynSchedule run outreach, scheduling and reminders within the rules your team sets, ZynScribe drafts notes for physician review and approval, and staff take every clinical question and exception. This “integrate, automate, govern” approach is built to remove the manual steps between insight and action.
Medicare Advantage organizations face unique challenges in care gap closure: complex quality measure requirements (HEDIS, Stars), risk adjustment accuracy (HCC coding), and member engagement across diverse populations. Zynix AI addresses each of these:
Health systems deploying Zynix AI across their value-based care operations look for measurable results in four areas, and our customer stories describe what individual customers have reported:
Whether you're an ACO managing risk-based contracts, a health system expanding Medicare Advantage enrollment, or an FQHC navigating quality reporting requirements, Zynix AI provides the unified platform to succeed in value-based care. The platform integrates with your existing EHR—Epic, Cerner, Athenahealth, and others—and deploys AI agents that work within the rules and escalation paths your team sets.
Explore solutions for health systems | Explore solutions for FQHCs | Learn about the Zynix platform
Risk stratification sorts a patient population by the likelihood of costly events, such as a hospital admission, readmission or emergency visit, so care teams can reach the patients who need help first. Current models combine diagnoses, utilization, medication adherence and social needs, and they flag rising-risk patients whose trajectory is worsening before an acute event, not only those who are already high cost.
Detection finds the gap; agents do the repetitive work of closing it. They contact patients by phone or text, explain the screening or visit that is due, book the appointment, send reminders and follow up on missed visits, all within the rules and hours your team sets. Clinical questions go to a nurse or physician by rule, and the gap closes when the visit or test is documented.
Start from your EHR mix and the work you need covered. Organizations that run a single EHR often begin with that vendor’s population health tools. Networks with many EHRs, or teams that also need the outreach and scheduling after a flagged gap, should test how each option connects to all their practices and who does the follow-up. Ask every vendor for a pilot on your own data.
No. Agents handle outreach, scheduling, reminders and documentation prep, and they escalate to the care team by rule. Licensed clinical staff own clinical judgment and the billable interactive contact for Transitional Care Management, which CMS requires within two business days of discharge for CPT 99495 and 99496. Agents never diagnose, triage clinically or recommend treatment.
CMS: CMS Moves Closer to Accountable Care Goals with 2025 ACO Initiatives (fact sheet, January 15, 2025). https://www.cms.gov/newsroom/fact-sheets/cms-moves-closer-accountable-care-goals-2025-aco-initiatives
CMS: Transitional Care Management Services (MLN908628, August 2025). https://www.cms.gov/files/document/mln908628-transitional-care-management-services.pdf
Epic: Population Health. https://www.epic.com/software/population-health/
Oracle Health: Population Health. https://www.oracle.com/health/population-health/
Innovaccer: The Agentic Cloud for Healthcare (Data Activation Platform, Agents of Care, ambient documentation). https://innovaccer.com/
Jay Chowdappa, MD is co-founder and CEO of Zynix AI. He is a physician, and ACOs led by him generated $300M+ in shared savings before he started Zynix AI to help care teams follow through on what their data already shows.