Geriatric APCM & CCM Automation FAQ | Tile Healthcare

During scheduled APCM check-ins, the AI conducts standardized falls risk assessments. It asks about recent stumbles, home hazards, and lighting. If a high risk is detected, the AI immediately flags the case for a geriatric nurse practitioner to intervene, preventing costly hospitalizations.

The AI conducts monthly medication reviews by prompting patients to read labels of current prescriptions. It cross-references these with the EHR to identify potential duplicates or omitted doses, a critical function for geriatric patients often seeing multiple specialists.

The platform can be configured to dial ALF nursing stations directly for patient updates. It automates the data exchange between the medical director’s office and the facility staff, ensuring that changes in condition are logged and addressed without repetitive phone tag.

The AI can be programmed to gently screen for the presence of updated Advance Directives or Physician Orders for Life-Sustaining Treatment (POLST). If these documents are missing, the AI flags the record so the physician can finalize end-of-life preferences during the next visit.

Following a hospital or SNF discharge, the AI initiates a 'Transition of Care' sequence. It checks for new medications, schedules follow-up appointments, and monitors for red-flag symptoms, which is vital for reducing the high readmission rates seen in the 65+ population.

Our AI scripts include subtle, validated screening questions for social isolation, food insecurity, and safety. If responses indicate potential neglect or abuse, the system triggers an immediate high-priority alert to the clinical lead for regulatory reporting and intervention.