In a 50,000-member cohort study, NightingaleMD closed 75% of open HEDIS gaps while maintaining 92% patient satisfaction. The system escalates to clinical staff when medical judgment is required—combining automation efficiency with clinical expertise.
Systematic approach to quality measure closure with documented outcomes
Gap Closure Rate
Population Coverage
Cost Reduction
Data from Q1 2026 multi-site deployment, n=50,000 members
Reviews complete medical records to identify documented and suspected gaps per NCQA specifications
Contact attempts via voice, text, and secure messaging. Average 3.2 attempts per successful closure
Integrates with provider scheduling systems. 68% same-week appointment availability achieved
Real-time verification through claims data and lab results. 96% accuracy in gap closure confirmation
Based on CMS 5-star quality bonus payments and typical MA contract rates
Evidence-based escalation protocols ensure appropriate resource allocation
Routine gap identification, appointment scheduling, medication adherence follow-up
Complex scheduling, SDOH barriers, member advocacy
Health assessments, care plan modifications, clinical education
Complex medical decisions, urgent interventions
Beyond gap closure: Managing transitions and chronic conditions
Centralized hub for member interactions with intelligent routing to appropriate clinical resources
Clinical outcomes data from current implementations
In a 12-month deployment across 3 ACOs, participating practices achieved:
Manage entire attributed populations without proportional staff increases
Physicians report 3+ hours/week reclaimed for direct patient care
Real-time dashboards aligned with CMS quality reporting requirements
Documented quality improvements strengthen contract negotiations
23% reduction in preventable readmissions within 90 days
Week 1
Week 2-3
Week 3-4
Day 30
Documented Star Rating improvements across multiple contracts
PDC rates improved 12-18% across therapeutic classes
TRC measure: 89% completion within 30 days
15 measures averaging 75% completion
Member experience: 92% satisfaction
Replace fragmented vendor solutions with integrated platform
Meeting state requirements while improving member outcomes
65% successful contact rate using multi-source data verification
30+ languages including regional dialects
Z-code capture increased 340% with systematic screening
Automated reporting meets evolving requirements
Q1-Q2 2026 deployment results
Hawaii Department of Health, Q1 2026 Report
Evidence-based algorithms with continuous outcome validation
Trained on 10M+ clinical interactions with continuous learning from validated outcomes
Medical terminology recognition in 30+ languages
HIPAA, SOC 2 Type II, HITRUST certified
HL7 FHIR compatible with major platforms
Real-time quality measure tracking
Aligned with quality performance outcomes
Replaces traditional nurse line services
Typical ROI: $450+ PMPY
Risk-sharing arrangement available
Pricing is PMPM-based with gain share in premium tiers
Experience Florence AI Navigator handling a typical member interaction
Member Interaction Example
Florence:
Member:
Florence:
Member:
Florence:
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Florence:
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Florence:
Outcome: 2 HEDIS gaps scheduled for closure, transportation arranged, member barrier removed
Join healthcare organizations achieving measurable improvements in quality outcomes