Use cases

Value-based care workflows, step by step

Grouped by program: transitions of care, risk adjustment and quality, chronic care, after-hours access, care navigation and front-office work. Filter by organization type.

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5 use cases

Transitions of care

ADT-triggered outreach inside the TCM window, through the follow-up visit.Runs on Transitions of care agent · ZynSchedule · Post-discharge TCM care plan

For ACOs · MSOs, IPAs & physician groups · Health systems

Post-discharge TCM across your attributed panel

Discharges from any hospital in your market start outreach, a nurse-led TCM contact and a booked follow-up visit.

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For Health plans · ACOs

Post-discharge follow-up for Medicare Advantage members

ADT feeds, not claims, start member outreach after a hospital stay, with care managers taking every clinical question.

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For Health systems · ACOs

Post-discharge follow-up across your hospitals

ADT-triggered calls after every discharge across your hospitals, with nurses taking the clinical questions and the TCM contact.

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For FQHCs & community health · ACOs

Post-discharge follow-up for community health patients

Outreach after a hospital stay in the patient’s preferred language, with transportation and other barriers routed to your care team.

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For Surgery centers · Health systems

Follow-up calls after an outpatient procedure

Structured calls in the days after surgery, with wound, pain and medication concerns routed to your clinical team.

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5 use cases

Risk adjustment & quality gaps

HCC and HEDIS gaps worked from the list to a documented visit.Runs on Care gap and HCC detection · Preventive and quality activation agent · HCC gap closure sprint

For ACOs · MSOs, IPAs & physician groups · Health systems

HCC recapture before the performance year closes

Open HCC gaps ranked by impact and deadline, pre-visit summaries for clinicians and outreach for patients with no visit booked.

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For Health plans · ACOs

Risk adjustment visits for Medicare Advantage members

Members with conditions not yet documented this year are invited to a visit, and providers see the open gaps before the member arrives.

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For Health plans

HEDIS gaps closed before the measurement year ends

Two-way member outreach that finds out why a measure is still open and books the screening, lab or visit.

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For Health systems · ACOs

HCC gap closure across a health system ACO

Pre-visit gap summaries for scheduled patients, and outreach to bring in the ones with no visit on the books.

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For FQHCs & community health · ACOs · Health plans

Preventive screening outreach for high-barrier patients

Outreach that asks why a screening is still open, books it and routes transportation or cost barriers to your team.

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5 use cases

Chronic care & adherence

Monthly CCM contact, adherence check-ins and outreach when risk starts to rise.Runs on Chronic care management agent · Rising-risk outreach agent · Medication safety and adherence plan

For ACOs · MSOs, IPAs & physician groups · Health systems · Health plans

Chronic care management across your panel

Monthly check-ins for patients in chronic care programs, with changes in symptoms or adherence routed to care managers.

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For ACOs · MSOs, IPAs & physician groups · Health plans · Health systems

Outreach to rising-risk patients before an admission

When claims, labs or utilization show risk climbing, the rising-risk outreach agent checks in and books a visit.

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For MSOs, IPAs & physician groups · ACOs · FQHCs & community health

Monthly CCM check-ins for independent practices

The monthly chronic care touchpoint, run for every enrolled patient, with clinical questions routed to the practice.

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For Health plans · ACOs · FQHCs & community health

Medication adherence outreach for Stars measures

Conversations with members who stopped filling a medication, with side effects routed to a pharmacist and cost questions to member services.

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For FQHCs & community health · Health plans · ACOs

Adherence check-ins for patients on complex regimens

Two-way check-ins for patients managing several chronic conditions, with side effects and cost barriers routed to the right person.

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4 use cases

After-hours access

After-hours calls answered, with symptom questions routed to your on-call clinician.Runs on ZynAfterHours · ZynSchedule

For ACOs · MSOs, IPAs & physician groups · Health systems · Health plans

After-hours access for your attributed patients

An after-hours answer for attributed patients, so routine needs get a morning visit instead of an ED trip.

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For MSOs, IPAs & physician groups · ACOs

After-hours calls for independent practices

Calls answered after the office closes, next-morning visits booked and symptom questions sent to the physician on call.

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For Health systems · ACOs

After-hours calls answered at every site

One consistent after-hours line across your sites: the reason captured, routine visits booked, symptom questions to the on-call clinician.

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For FQHCs & community health · MSOs, IPAs & physician groups

After-hours access in your patients’ languages

After-hours calls answered in the caller’s preferred language, with symptom questions routed to your on-call clinician.

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3 use cases

Care navigation & SDoH

Screening, resource referrals and follow-up for patients facing barriers.Runs on Referral management agent · Chronic care management agent · Care coordinators

For MSOs, IPAs & physician groups · ACOs · Health systems

Referrals tracked to a completed specialist visit

The referral management agent follows each referral until the specialist visit happens and the result comes back.

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For Health plans · ACOs · Health systems

Steady outreach for high-utilizer members

Routine contact between case management calls for members with frequent admissions and ED visits, with changes routed to case managers.

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For FQHCs & community health · ACOs · Health systems

Social needs screening that leads to follow-up

Barriers patients mention during outreach are captured and routed to a coordinator, not left in a screening form.

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8 use cases

Front-office work & documentation

Referrals, fax intake, scheduling, authorization paperwork and visit notes.Runs on ZynFax · ZynSchedule · Referral management agent · ZynScribe

For MSOs, IPAs & physician groups · FQHCs & community health

Appointment scheduling and no-show follow-up

Two-way confirmations that ask what is in the way, reschedule early and offer freed slots to patients on the waitlist.

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For MSOs, IPAs & physician groups · Surgery centers · ACOs

Prior authorization paperwork for independent practices

Payer responses routed to the right person and approved visits booked, while practice staff keep ownership of each request.

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For Health systems · Surgery centers

Prior authorization paperwork for specialty service lines

Payer faxes for specialty authorizations read, matched and routed, and approved cases booked, while your staff own each request.

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For Health systems · MSOs, IPAs & physician groups

Visit notes drafted during the visit

ZynScribe drafts a structured note from the visit conversation; nothing is filed until the physician approves it.

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For Surgery centers · Health systems

Authorization paperwork for surgical cases

Payer responses for surgical cases routed to the right person, so approved cases are confirmed before the OR date.

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For Surgery centers · MSOs, IPAs & physician groups

Referral intake for surgery centers

Referral packets read, matched to the patient, checked for missing items and routed before your intake team starts the day.

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For Surgery centers

Scheduling and pre-procedure preparation

Preparation outreach before each case: labs, medication holds, fasting and transportation confirmed, with gaps routed to staff.

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For Surgery centers · Health systems · MSOs, IPAs & physician groups

Inbound fax sorted, matched and routed

Every inbound fax read, classified, matched to the patient and routed to the right queue, with urgent items flagged.

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Related

By organization

Solutions overview Built for each type of organization →

Customer stories How value-based care teams use Zynix →

Platform

All AI agents How agents work with your care team →

Care plans TCM, AWV and CCM workflows →

Platform overview One platform for value-based care operations →

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