CommuniCare Health Services-one of the nation's largest post-acute care providers-needed to optimize MDS assessments across their skilled nursing facilities. We built AI-powered tools that transformed PDPM revenue capture while improving quality scores.
PDPM Revenue Recovered
Quality Incentives (Annual)
Five-Star QM Score
Time Savings Per Assessment
CommuniCare's MDS coordinators were drowning. Each assessment took 3-4 hours, and with hundreds of residents across multiple states, they were missing diagnoses that directly impacted PDPM reimbursement.
The problem wasn't competence-it was capacity. Coordinators didn't have time to review every clinical note, lab result, and medication record for every resident. Diagnoses were being missed. Revenue was walking out the door.
3-4 hours per MDS assessment
Manual review of clinical documentation, medications, lab results
Missed diagnoses everywhere
Not enough time to catch everything buried in the chart
Revenue leakage at scale
Hundreds of residents, millions in missed reimbursement
Quality scores suffering
Incomplete documentation affecting Five-Star ratings
We didn't build an algorithm and hand it over. We embedded with CommuniCare's MDS team, shadowed their workflows, and co-designed a solution that actually fit how they work.
Our AI reviews clinical documentation, medications, and lab results to surface diagnoses that should be captured on the MDS. Every recommendation linked to supporting documentation-audit-ready from day one.
Before MDS submission, AI flags potential errors, missing diagnoses, and inconsistencies. Catch problems before they become denials or audit findings.
Real-time visibility into quality measure performance across facilities. Identify improvement opportunities, track progress, and prepare for surveys.
This wasn't just an AI project. It was a complete transformation-from messy data to measurable outcomes. Here's how each step contributed to success.
Integrated clinical data from PointClickCare across multiple facilities. Cleaned and structured medication records, lab results, and clinical notes into AI-ready format.
Built AI using peer-reviewed CMS scoring models. Every recommendation explainable and linked to source documentation. 90%+ diagnosis accuracy validated.
Seamless PointClickCare integration. AI recommendations surface within existing workflow-no separate login, no duplicate data entry.
40+ hours shadowing MDS coordinators before writing code. Weekly feedback sessions throughout development. They own the solution because they helped create it.
Phased rollout starting with pilot facilities. On-site go-live support. Rapid issue resolution. No "deploy and disappear."
Training programs for MDS coordinators. Super-user identification. Resistance addressed head-on. Adoption from day one-not months later.
Continuous optimization based on CMS updates and CommuniCare feedback. System improves over time. Learning from their data creates competitive advantage.
$10M PDPM + $2M quality incentives-financial analyst calculated, not vendor estimates. Transparent reporting. Results that speak for themselves.
These numbers aren't projections or vendor marketing. They're validated results from CommuniCare's financial team, tracking actual PDPM reimbursement and quality incentive payments.
From two states, annualized. Diagnoses previously missed now captured through AI-powered recommendations.
Annual quality incentive payments earned through improved quality measure performance.
Per patient benefit from more accurate case mix index classification.
MDS coordinators spend less time hunting through charts, more time on clinical judgment.
Quality measure performance improved through better documentation and coding accuracy.
AI recommendations validated against clinical documentation with high accuracy.
Most healthcare AI projects fail because they're built in conference rooms, not clinical settings. We took a different approach.
Before writing a single line of code, our team spent 40+ hours shadowing MDS coordinators. Watching their actual workflow. Understanding their pain points. Learning their language.
Every AI recommendation is linked to supporting clinical documentation. When auditors ask "why did you capture this diagnosis?"-there's an answer ready. Defensible from day one.
Change management isn't an afterthought. We trained coordinators, identified super-users, addressed resistance head-on. The solution works because people actually use it.
If missed diagnoses are costing you millions in PDPM reimbursement, let's talk. 30-minute call to assess your opportunity.
Schedule Assessment CallRelated Insights
Dec 23, 2025
Nov 03, 2025
Jul 09, 2025
