This Startup Streamlines Health Care Referrals

When medical doctors within the United States refer sufferers to specialty or post-acute medical care akin to physical therapy or long-term nursing care, nearly half never complete the process of discovering assist. Referrals stall partially as a result of supplier directories are outdated, insurance coverage protection is unclear, and far coordination nonetheless depends on telephone calls and faxes.

Carenector, a Denver-based startup launched in 2024, is working to enhance the method with software program that shortly connects sufferers with applicable care suppliers whereas defending their personal data. As an alternative of presenting an extended checklist of suppliers, lots of whom wouldn’t be an excellent match, the corporate’s referral platform makes use of AI to eradicate services that don’t meet the affected person’s rehabilitation wants, don’t settle for the affected person’s insurance coverage, or are usually not conveniently situated.

The startup’s platform serves people searching for care in addition to health care organizations and care coordination groups that handle affected person referrals. The corporate goals to assist sufferers whereas decreasing the executive burden on clinicians and discharge planners, says cofounder Naheem Noah. As of now, Carenector works with sufferers and services solely in Colorado, however it plans to broaden protection nationwide.

Noah, a Ph.D. candidate who joined IEEE in 2022 as a pupil member, encountered the referral drawback firsthand after tearing an anterior cruciate ligament in a knee whereas taking part in soccer. Discovering a bodily therapist who accepted his insurance coverage, specialised in ACL rehabilitation, had appointments obtainable, and was close to his house required hours of telephone calls and searches by inaccurate supplier lists, he says.

That have helped form the corporate’s route, however Carenector is geared toward a broader, persistent failure in U.S. well being care coordination.

A damaged referral system

The corporate took form when Noah related along with his cofounder, licensed social employee Aminata Diarra, a social director at a nursing facility. Her function included discharge planning: inserting sufferers in post-acute-care services that bridge the hole between hospital discharge and the affected person’s capacity to independently handle life’s every day actions.

For a single affected person, Diarra says, that always meant she made 10 to fifteen telephone calls over the course of every week to discover a facility with a mattress obtainable, that accepted the affected person’s insurance coverage, and that would meet the care necessities.

She and Noah quickly realized they had been coping with the identical damaged system from reverse sides. Present analysis on referral lapses supported their expertise. Main care physicians typically ship referral notes—analogous to prescriptions—that checklist the affected person’s medical historical past and describe the wanted remedy.

Noah found that solely about one-third of the notes are transmitted in a manner that permits suppliers at nursing houses and rehab services to entry the knowledge.

Physicians typically put up their solutions for ongoing remedy in sections of a affected person’s electronic health records, however suppliers at post-acute services don’t have entry to these due to medical privacy legal guidelines. What will get shared is a pared-down doc that omits progress notes and discharge summaries.

Engineering a research-driven startup

Noah is presently a researcher within the University of Denver pc science division, the place his tutorial work focuses on privateness and safety in digital methods.

He’s Carenector’s chief govt and technical lead, overseeing the system’s design, making technical choices, and assembly with traders.

Though the startup is separate from his dissertation analysis, the corporate displays his broader curiosity in constructing safe methods that work in real-world situations.

Starting an organization whereas a pupil, he has entry to college assets that many early-stage startups lack. He has participated within the college’s BaseCamp accelerator and obtained mentorship and enterprise planning assist.

The Carenector crew was assembled with the plan to scale up sooner or later with well being care compliance in thoughts. The group consists of professionals from regulatory, authorized, and information engineering fields.

Changing telephone calls with digital matching

By utilizing standardized digital data shared amongst medical services, Carenector eliminates the necessity for employees to make telephone calls or ship faxes. On the core of the platform is a structured database that hyperlinks care suppliers—together with post-acute, specialty, and rehabilitation services—with insurance coverage plan standards and facility attributes akin to accessibility and repair capabilities.

One of many greatest challenges for Noah is getting correct information on which companies services provide, which insurance coverage they settle for, and whether or not a affected person’s insurance coverage plan covers the remedy proposed by the referring doctor.

“Well being care data in the US shouldn’t be centralized,” he says, “and insurance coverage supplier directories are sometimes flawed or old-fashioned.”

To handle that, Carenector incorporates publicly obtainable datasets from the U.S. Centers for Medicare & Medicaid Services (CMS), together with plan attributes, service areas, high quality scores, and issuer-level transparency information. These public-use recordsdata present plan-level and provider-level data that assist standardize protection standards, geographic availability, and efficiency indicators. Carenector integrates this structured public information with facility-supplied data and referral end result analytics to enhance matching accuracy.

“By changing guide coordination with clear guidelines, correct information, and built-in privateness protections, we hope to make accessing care a routine step in restoration—not one other impediment.”

This structured information helps Carenector consider plan standards, supplier capabilities, geographic availability, and high quality indicators to assist referral decision-making. The corporate standardizes and organizes the knowledge inside its personal system architecture and makes use of mapping and geolocation APIs to combine location-based filtering and workflow performance for sufferers, suppliers, and care coordinators.

As a result of CMS information is up to date periodically, Carenector dietary supplements it with further structured information sources and referral end result analytics to raised perceive plan acceptance patterns. Room availability data comes instantly from taking part services, that are accountable for updating their standing inside Carenector’s system.

Whether or not referrals succeed or fail supplies important suggestions, Noah says. When referrals to particular services repeatedly go uncompleted—that means the affected person doesn’t obtain the really helpful care from the supplier—Carenector’s AI-driven matching algorithm adjusts to that sample and reduces the probability of that facility being thought of for related instances. Services that persistently settle for and full referrals are ranked preferentially.

Apps for sufferers and services

The corporate has poured its information administration wizardry and AI smarts into apps for sufferers and clinicians.

The affected person app helps customers find applicable well being care companies without charge. Customers can seek for care by service sort, ZIP code, or insurance coverage firm with out creating an account. They obtain a listing of matching services that may be shared by way of clipboard or despatched by e mail to themselves or members of the family..

Within the facility app, clinicians enter the analysis, rehabilitation wants, gear necessities, insurance coverage sort, and placement with out sharing personally identifiable affected person data. Organizations can talk utilizing safe messages that disappear after a set interval. Information and pictures are proven solely as soon as and deleted after viewing.

Services that use the app pay Carenector a flat payment for every profitable referral. The affected person app is free.

The startup doesn’t promote or share information with third events, Noah says.

“Privacy is a central design requirement for Carenector’s system, not a last-minute add-on to the completed product,” he says.

The corporate minimizes the gathering of private information to keep away from turning into a knowledge repository. Though its function is restricted to coordinating referrals, Carenector is working with impartial safety auditors to validate that its operational and data-handling practices align with Health Insurance Portability and Accountability Act (HIPAA) necessities. The HIPAA legislation units requirements meant to guard delicate affected person data from unauthorized disclosure.

Noah says he’s assured that Carenector will obtain that score as a result of the app is designed to scale back the gathering and publicity of delicate data wherever potential.

Enterprise mannequin and measured enlargement

Carenector’s development plan, Noah says, is strategic. Moderately than scaling quickly, he says, he’s seeking to enter one area at a time, incorporating suggestions from every native deployment earlier than increasing the corporate additional.

He envisions that in 5 years, Carenector will function a core piece of well being care referral infrastructure—embedded within the workflows of hospitals, post-acute services, insurers, employers, and main electronic health record methods akin to Epic and Cerner—whereas additionally rising visibility for care services in underserved and distant areas. The plan, he says, is to assist hundreds of facility suggestions per day, in contrast with the roughly 200 every day facility suggestions it presently generates. Noah additionally seems to be ahead to the broader adoption of APIs that permit care coordination and facility discovery to happen instantly inside medical workflows.

He says he sees his startup as a approach to cut back pointless stress from moments when sufferers are susceptible.

“By changing guide coordination with clear guidelines, correct information, and built-in privateness protections,” he says, “we hope to make accessing care a routine step in restoration—not one other impediment.”