Comprehensive solutions!

We are using AI, personalized medicine, and the FHIR data platform to tackle chronic disease.

Intersect on FHIR is a fully integrated, real-time virtual care platform designed to revolutionize chronic disease management.

Built on the industry-leading FHIR (Fast Healthcare Interoperability Resources) standard, our platform seamlessly connects patients, providers, and healthcare systems to enable proactive, data-driven care. With real-time remote monitoring, predictive analytics, and personalized digital health engagement, Intersect on FHIR empowers clinicians to identify risks early, optimize treatment plans, and enhance patient outcomes—all while improving care coordination and reducing costs. Whether integrated with existing EHRs or deployed as a standalone solution, Intersect on FHIR delivers scalable, value-based chronic disease management that adapts to the evolving needs of healthcare. Experience the future of connected care. Explore Intersect on FHIR today.

The platform connects a comprehensive ecosystem, including a point-of-care application for providers, a patient-centered mobile application, and healthcare organization EHR systems. This fully connected ecosystem ensures that every stakeholder in the care continuum—providers, patients, and healthcare organizations—can access the right data at the right time. The provider-facing point-of-care application enables seamless clinical decision-making with AI-powered insights, while the patient-centered mobile app fosters patient engagement through remote monitoring, personalized coaching, and real-time communication. Additionally, EHR integration allows healthcare organizations to synchronize data effortlessly, ensuring continuity of care across all settings. By unifying these components, Intersect on FHIR transforms chronic disease management into a dynamic, data-driven process—one that is continuous, personalized, and highly effective.

Here's how the process works - seamlessly and continuously.

Identify High-Risk Individuals and Those Already Afflicted

1. Leverage AI and Predictive Analytics

   - Use machine learning and FHIR-based patient data to proactively identify those at risk before symptoms worsen.

2. Utilize Population Health Data

   - Analyze EHR, social determinants of health (SDOH), genetic data, and lifestyle factors to find those most vulnerable.

3. Screening and Early Detection Programs

   - Remote monitoring can help catch cases earlier.




Diagnose and Assess Conditions for Management

1. Comprehensive Diagnostics

   - Use biomarkers, imaging, lab tests, and AI-driven decision support to confirm and categorize.

2. Risk Stratification

   - Segment patients based on severity, comorbidities, and likelihood of complications to tailor intervention levels.

3. Personalized Treatment Plans

   - Develop AI-assisted personalized medicine strategies for targeted therapies and lifestyle intervention.




Treat and Continuously Monitor Patients

1. Coordinated, Multidisciplinary Care

   - Primary care, specialists, and remote care teams collaborate through the INTERSECT on FHIR integrated data-sharing platform.

2. Remote Patient Monitoring (RPM)

   - Wearables, smart devices, and real-time tracking provide continuous updates.

3. AI-Powered personalized Medicine

   - Adaptive treatment plans adjust based on real-time patient data and predictive models

4. Medication Management and Adherence Support

   - AI-powered alerts, digital prescriptions, and pharmacist integration insure compliance.




Maintain Continous Dialogue and Engagement



1. 24/7 Virtual Care

   - Chronic disease care can not be episodic - it must be continuous and accessible from anywhere.

2. Patient Education and Digital Coaching

   - AI chatbots, mobile health apps, and digital health coaching empowers patients to take control.

3. Behavior and Mental Health Integration

   - Chronic conditions often come with stress, depression, and lifestyle challenges - integrating behavioral health support is essential.

4. Proactive Communication

   - Automated check-ins, smart reminders, and real-time alerts keep patients engaged in their own care




A fully Integrated, Data-Driven Approach is the Key

To make this work, the entire system is connected through:

1. FHIR-based Interoperability

   - A seamless data exchange between providers, payers, and digital health tools.

2. AI-Powered Decision Support

   - Automating risk detection, diagnosis, and treatment recommendations.

3. Patient-Centered Engagement

   - Keeping individuals actively involved in their care through the mobile app, virtual visits, and smart health tracking.
   
   

   With the system functioning in a contiuous loop, chronic disease management shifts from reactive and fragmented to proactive, personalized and highly effective.

   
   
   

   Despite having the technology and knowledge to identify, diagnose, treat, and monitor patients, healthcare systems often face roadblocks that prevent seamless chronic disease management. Here is a breakdown of the top barriers and how Intersect has overcome them:

   Key Challenges in Implementing a Seamless Chronic Disease Management System

   
   
   

   Fragmented Data and Lack of Interoperability

   The Problem

   1. Patient data is often scattered across EHRs, payer systems, specialty clinics, remote monitoring devices, and lab results.

   2. Many healthcare organzations lack full interoperability, making real-time data exchange difficult.

   
   
   

   The Solution

   1. INTERSECT'S FHIR-based data platform

      - Ensuring that structured data can be shared seamlessly across different healthcare providers.

   2. AI-Driven Integration

      - Using natural language processing (NLP) and predictive analytics to extract meaningful insights from unstructured data sources.

   3. Unified Patient Health Record

      - A single, longitudinal patient record, accessible across care teams, virtual visits, and remote monitoring.
   
   
   

   Early Identification and Diagnosis Gaps

   

   The Problem

   1. Many high-risk patients remain undiagnosed due to lack of routine screenings, genetic risk analysis, and proactive monitoring.

   2. Chronic conditions often progress silently until they become acute, leading to costlier, harder-to-manage outcomes.

   
   
   

   The Solution

   1. AI-Powered Risk Stratification

      - Analyzing EHRs, wearable data, genomics, and social determinat4es of health (SDOH) to flag at-risk populations early.

   2. Community-Based and Remote Screening Programs

      - Expanding access to AI-driven diagnostic tools via pharmacies, mobile health units, and digital self-assessments.

   3. Incentivised Prevetative Care

      - Aligning value-based care models to reward early diagnosis and intervention insteaded of treating only acute cases.
   
   
   

   Lack of Continuous Engagement and Adherence

   The Problem

   1. Many patients don't adhere to medications, lifestyle changes, or follow-up appointments due to cost, complexity of lack of motivation.

   2. Chronic disease management often relies on episodic doctor visits, leading to a gap in care.

   
   
   

   The Solution

   1. Digital Health Coaching and Smart Nudges

      - AI-driven apps that provide personalized education , reminders, and motivation to improve adherence.

   2. Behavioral AI and Gamification-

      - Reward-based systems that encourage small, sustainable lifestyle changes.

   3. 24/7 Virtual Care Teams and Chatbots

      - Continuous engagement though remote monitoring, instant messaging with clinicians, and automated alerts for abnormal vitals.
   
   
   

   Workforce and Scalability Limitations

   

   The Problem

   1. Healthcare Systems are already overwhelmed with staff shortages, making long-term chronic disease management difficult to scale

   2. Manual patient monitoring is labor intensive, leading to burnout among care teams

   
   
   

   The Solution

   1. AI-Powered Clinical Decision Support (CDS)

      - Automating routine tasks like chart reviews, risk assessments, and care plan optimization.

   2. Virtual Care Models (Remote Monitoring, eConsults)

      - Reducing strain on hospitals by shirting care to digital platforms.

   3. AI-Driven Triage and Automation

      - Helping nurses and care coordinators manage larger patient populations with AI-driven risk prioritization.
   
   
   

   Payment and Reimbursement Barriers

   The Problem

   1. Many value-based care models are still underdeveloped. making it hard for providers to get reimbursed for proactive, tech-driven interventions.

   2. Remote monitoring, AI diagnostics, and telehealth services often face coverage limitations from insurers.

   
   
   

   The Solution

   1. Adapt your program to meet existing CMS chronic disease management reimbursement rules.

      - Existing CMS chronic disease management CPT codes offer attractive reimbursement opportunities.

   2. Leverage Clinical Staff

      - Selected CMS programs allow monitoring programs to be administered by clinical staff with supervision from physicians.

   3. Data-Backed ROI Evidence for Payers

      - Demonstrated cost savings through reduced hospitalizations, ER visits, and medication non-adherence.
   
   
   

   Hospitals that provide comprehensive chronic disease management see lower costs and better patient health outcomes, leading to higher satisfaction and loyalty.

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   1. ✅ Enhanced Care Coordination –Integrating chronic disease management with telehealth, eConsults, and remote monitoring improves coordination between primary care, specialists, and hospital systems.
   2. ✅ Compliance with Value-Based Care Models –Effective chronic disease management aligns with value-based reimbursement models, such as CMS’s ACOs and bundled payments, helping hospitals receive better reimbursements.
   3. ✅ Optimized Resource Allocation – Fewer avoidable admissions free up hospital resources for acute and emergent care, improving efficiency
   4. ✅ Better Population Health Management – Hospitals that leverage AI and FHIR data platforms can track chronic disease trends, enabling data-driven decisions for improving community health.

      For patients

      • ✅ Better Health Outcomes – Regular monitoring and early intervention prevent disease progression and complications.
      • ✅ Improved Quality of Life – Managing chronic conditions allows platients to remain active and engaged in daily life.
      • ✅ Reduced Healthcare Costs – Preventive care and early management lower out-of-pocket expenses for emergency visits, hospitalizations, and medications.
      • ✅ Increased Access to Care – Telehealth, remote monitoring, and hospital-at-home programs provide continuous access to healthcare, reducing barriers like transportation and scheduling.
      • ✅ Personalized Treatment Plans – AI-driven personalized medicine enhances treatment effectiveness, ensuring tailored care based on patient genetics, lifestyle, and health history./li>/
      • ✅ Empowered Self-Management – Digital health tools and AI-driven insights help patients monitor their conditions and make informed lifestyle choices.
      • ✅ Lower Risk of Complications –Managing conditions like diabetes, hypertension, and heart disease reduces the risk of severe complications such as stroke, heart attacks, and kidney failure.

      Are you ready to revolutionize chronic disease managment? Let's talk.

      Explore how INTERSECT on FHIR and INTERSECT's services offering can power your organization forward. Join the movement toward proactive, personalized, and connected care.