Workflow GuideTile Health vs Phamily

Tile Health vs Phamily: Chronic Care Risk Stratification Guide

Compare Tile Health and Phamily for AI chronic care risk stratification. Learn how automation impacts staffing, ROI, and patient engagement workflows.

Effective risk stratification is the foundation of profitable Chronic Care Management (CCM) and APCM. While Phamily uses AI to assist human care managers in identifying high-risk patients, Tile Health leverages fully autonomous AI agents to stratify and engage patients directly via voice. This guide explores the workflow differences between these two leading AI approaches.

The Challenge

Manual risk stratification leads to missed revenue and clinician burnout, as teams struggle to balance complex EHR data analysis with the high volume of patient outreach required for compliance and reimbursement.

Step-by-Step Workflow

1

EHR Data Integration and Synthesis

Connect the platform to your EHR to pull diagnosis codes, lab results, and encounter history. Tile Health prioritizes real-time data ingestion for immediate risk flagging.

Best Practices
  • Ensure bi-directional syncing is active to prevent data silos.
  • Map all relevant ICD-10 codes for chronic conditions early.
Common Pitfalls
  • Relying on manual CSV exports which lag behind real-time clinical status changes.
2

AI-Driven Patient Identification

Apply proprietary algorithms to filter patients meeting CCM/APCM criteria. Phamily highlights patients for care manager review, while Tile Health prepares them for automated outreach.

Best Practices
  • Look for algorithms that identify the 'rising risk' population, not just high utilizers.
  • Segment patients by insurance type to optimize for specific reimbursement models.
Common Pitfalls
  • Over-focusing on the top 5% of high-risk patients while ignoring the 20% who are trending upward.
3

Automated Outreach and Validation

Use AI to contact identified patients. Tile Health uses autonomous voice agents to verify symptoms and social determinants of health (SDOH) without requiring human staff time.

Best Practices
  • Tile Health's voice AI can handle thousands of concurrent calls for rapid stratification.
  • Use Phamily's platform if you prefer human care managers to lead every conversation.
Common Pitfalls
  • Scaling outreach by hiring more staff rather than utilizing phone automation.
4

Clinical Risk Level Assignment

Categorize patients into risk tiers based on AI findings. This determines the frequency of monitoring and the intensity of the care plan required for compliance.

Best Practices
  • Automate the documentation of risk level changes in the EHR for audit trails.
  • Set triggers for immediate escalation to a provider for high-risk flags.
Common Pitfalls
  • Inconsistent risk labeling across different care managers in a manual model.
5

Enrollment and Digital Consent Capture

Capture the necessary patient consent for CCM services. Tile Health automates this during the stratification call, while Phamily provides tools for human-led enrollment.

Best Practices
  • Ensure the AI voice agent is programmed to explain the specific benefits of APCM.
  • Store time-stamped consent records directly in the patient profile.
Common Pitfalls
  • Failing to document the exact time and date of verbal consent, risking billing audits.
6

Staffing and ROI Optimization

Analyze the staffing cost versus revenue. Phamily aims for high revenue per patient via human-led care, whereas Tile Health maximizes net profit by reducing the need for clinical staff.

Best Practices
  • Calculate your net ROI by subtracting the cost of care managers from the total reimbursement.
  • Consider the 'opportunity cost' of using nurses for outreach instead of clinical tasks.
Common Pitfalls
  • Focusing on gross revenue figures without accounting for the high cost of human-in-the-loop staffing.

Expected Outcomes

1

Significant reduction in clinical staff hours spent on manual patient outreach.

2

Higher enrollment rates for CCM and APCM programs through rapid AI identification.

3

Improved audit readiness with automated documentation of risk stratification logic.

4

Increased net profit per patient by minimizing human operational overhead.

5

Faster identification and intervention for high-risk chronic patients.

Frequently Asked Questions

No. Tile Health is designed for full automation, meaning the AI handles the bulk of the outreach and stratification, whereas Phamily is a productivity tool for existing care management staff.

Phamily highlights high gross revenue (approx. $578K per 1000 patients), but Tile Health focuses on maximizing net profit by eliminating the significant salary costs associated with human care managers.

Yes, Tile Health provides a fully HIPAA-compliant AI environment, including BAA execution and secure data handling, meeting the same rigorous standards as Phamily.

Both support APCM, but Tile Health is better suited for practices looking to meet the high-volume documentation and engagement requirements without hiring additional full-time employees.

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Tile Health vs Phamily: Chronic Care Risk Stratification Guide | Tile Health