Value-based care rewards outcomes, not volume. That requires a different kind of AI — one that closes gaps, captures risk, coordinates care, and governs every automated decision. blueBriX is the first open orchestration platform built specifically for this mission.
Value-based care contracts live or die on specificity — the right risk code, the right gap closed at the right time, the right care plan for the right patient. Generic AI creates generic results. In VBC, generic is expensive.
"Diabetes" coded instead of "Type 2 Diabetes with CKD Stage 3" costs you capitation revenue every cycle.
Identifying open HEDIS gaps at reporting time means you've already lost the quality bonus.
If their risk model doesn't fit your population or payer mix, you have no recourse in a walled-garden platform.
AI that suggests codes and care actions without validation against your specific contract terms is a compliance liability.
In value-based care, the AI model matters less than what surrounds it: the longitudinal patient data it reasons over, the contract rules that validate its suggestions, and the clinical workflows that carry out its decisions.
blueBriX provides the Context (unified longitudinal record), the Governance (payer rules, VBC contract logic, compliance), and the Consequences (full-stack execution: EHR → RCM → Care Coordination → Engagement).
The intelligence — the AI agent itself — can be ours, a best-in-class third party, or your own. That’s the open orchestration difference.
VBC success isn't about having the most AI. It's about having AI that's connected, governed, and composable enough to keep up with how value-based contracts evolve.
A risk stratification agent is only valuable if it can trigger an outreach. A coding agent is only valuable if it can submit the claim. Because blueBriX owns the entire stack — EHR, RCM, Care Coordination, and Engagement — agents don't just suggest, they execute. That's the full-stack VBC advantage.
Every VBC contract has unique rules: payer-specific HCC models, shared-savings thresholds, HEDIS measure specifications, and CMS quality requirements. The blueBriX Trust Engine encodes your contract terms and validates every AI-driven action against them before execution — native agents and third-party agents alike.
VBC contracts evolve. Payer relationships shift. New quality measures emerge. The best AI model for HCC coding today may not be best in 18 months. blueBriX's open architecture lets you swap the intelligence as the market moves — without replacing the platform, re-implementing workflows, or renegotiating your data infrastructure.
The platform is live. Partner agents are pre-validated and ready to deploy. Native agents are in active development — built inside the Governance Layer for the deepest possible VBC integration.
Whether an agent is handling HCC coding, care gap closure, or denial management — native or third-party — it passes through the same governance layer before touching your contracts, data, or patients.
Pre-validated partner agents (live now) and native blueBriX agents (in active development) — covering risk adjustment, care gaps, transitions of care, denial management, CCM, and more.
Every suggestion validated against your VBC contract terms, payer-specific rules, HEDIS/STARS specs, and CMS compliance requirements. AI suggests; the platform validates.
Full-stack execution: EHR, RCM, Care Coordination, and Patient Engagement carry out the agent's validated decisions — closing the loop from insight to action.
One longitudinal patient record powering risk stratification, quality measures, and population health analytics. FHIR-native, HL7-compatible, API-first.
Agents are the intelligence. The platform is the nervous system. Governance is the contract-compliance engine.
VBC contracts evolve year over year. What's best for risk adjustment in 2026 may not be in 2028. blueBriX decouples the platform from the model — so you can swap intelligence as the market moves without ever re-implementing your workflows.
Connect any existing AI investment to blueBriX through the governed API layer. Your agent gains full-stack access to patient data and workflow execution — governed by the same Trust Engine as our native agents.
HCC coding and RAF score optimization, pre-validated against your payer's HCC model inside the blueBriX rules engine.
✓ Live & Governance-ValidatedHigh-volume PA automation plugged into blueBriX's execution layer — approvals trigger the next care workflow automatically.
✓ Live & Governance-ValidatedConnect your ambient scribe of choice. blueBriX validates note completeness and coding specificity before finalization.
✓ Live & Governance-ValidatedVoice and messaging AI for care gap outreach, scheduling, and post-discharge follow-up — executed through the Engagement module.
✓ Live & Governance-ValidatedVBC contracts are legally binding. Every HCC code, care plan action, and quality measure submission needs to be defensible. The blueBriX Trust Engine ensures every AI decision — from any agent — is validated before it counts.
Any agent (native or 3rd party) drafts an HCC code, care plan, quality action, or claim.
blueBriX checks against your VBC contract terms, payer rules, CMS requirements, and clinical protocols.
Only validated actions reach the platform — with a full audit trail for every payer, program, and contract.
Same governance standard, every agent. Native, third-party, or BYOA — the contract is always the authority.
From the care coordinator closing gaps to the CFO protecting shared-savings performance — AI orchestration solves a different problem for every stakeholder managing a value-based care program.
Care teams get ahead of patient needs instead of reacting to crises. AI agents identify open care gaps and automatically trigger personalized outreach — preventive care nudges, chronic condition check-ins, appointment reminders — all managed and tracked by the care team in one unified view.
Care gaps discovered reactively, coordinators manually chasing patients
AI-triggered outreach, care team tracks every patient touchpoint in one platform
Referrals, transitions of care, and post-discharge follow-ups are tracked, flagged, and acted on automatically. Providers see exactly where each patient is in their journey — without chasing records across fragmented systems or waiting for a readmission to surface a missed handoff.
Referrals lost, discharge follow-ups missed, providers unaware of prior encounters
Full care journey visibility with automated alerts for at-risk transitions
Under VBC, accurate risk adjustment is not just a coding task — it's a financial imperative. AI agents surface the full specificity of a patient's condition burden, lifting RAF scores that reflect true complexity. Every suggestion validated against your payer's HCC model before submission.
HCC under-coding and missed specificity eroding capitation revenue every cycle
Full condition capture, payer-validated, with defensible audit trail per submission
In value-based arrangements, denials don't just delay payment — they disrupt care coordination data. AI agents pre-scrub claims against payer-specific rules, cutting denials and accelerating cash flow while keeping quality data clean.
Manual rework cycles, slow month-end close, denial patterns opaque
Automated payer-specific scrubbing, targeting 90%+ first-pass yield
Stop managing value-based contracts with month-old data. AI-powered dashboards surface shared-savings performance, quality measure progress, risk score trends, and care gap status as care is delivered — enabling course corrections before the contract period closes.
Learning contract performance too late to course-correct; surprises at reconciliation
Real-time VBC command center across all programs, payers, and quality measures
A 5-year contract with a closed AI platform is a bet that their models stay best for every VBC workflow. With blueBriX, you buy an architecture that appreciates as the AI ecosystem evolves — swap agents as better models emerge, without re-implementing the platform.
Locked into one vendor's AI roadmap as your VBC contracts grow more complex
Composable architecture — best agent for each workflow, always
One consistent risk lens across your entire attributed population. AI agents identify rising-risk patients, flag open HEDIS/STARS gaps, and trigger care plans before a condition escalates — turning retrospective quality reporting into real-time intervention.
Open quality gaps discovered at reporting time — already too late to close
Real-time gap detection with automated care plan activation and outreach
Care coordinators managing VBC programs lose significant time to documentation, prior auth, and administrative follow-up. AI agents handle these workflows — governed by the same safety layer — freeing clinical staff to focus on closing gaps and improving outcomes that matter for the contract.
Coordinators spending 40–60% of time on admin instead of care management
AI handles admin; care teams focus on the outcomes that drive VBC success
FHIR-native, HL7-compatible, built on open APIs and microservices — no costly interface taxes to connect new AI tools. New agents plug in through the governed API layer, not brittle point-to-point integrations that break at every EHR upgrade.
Custom integrations for every new AI tool, each one a maintenance liability
One governed API layer for any agent, any system, any payer
SOC 2-compliant infrastructure, HITRUST certification pathway, and a governance layer that applies the same compliance standard to every agent — native, third-party, or BYOA. No compliance blind spots when you add new AI tools.
Black-box AI with no audit trail, unknown compliance posture for 3rd-party agents
Universal governance, full audit trail, same standard for every agent on the platform
Our native agents are built inside the Governance Layer — tighter VBC contract integration, deeper payer rule validation, and safer execution than any third-party agent can achieve on its own.
VBC contract rules, payer logic, CMS compliance
LiveOpen governed integration layer with full audit trail
LiveClinical and financial execution backbone
LiveHEDIS/STARS detection + automated outreach trigger
NativePre-submission claim scrubbing + appeal routing
NativeTransition monitoring + at-risk patient alerts
NativeCMS CCM billing documentation + monthly touchpoints
NativeUnderpayment detection + contract optimization
NativeWhole-person care with community resource routing
NativeRoadmap subject to change. Native agents are built inside the Governance Layer — the same layer governing every partner agent today.
Every year, payer models shift, new quality measures are introduced, and better AI tools emerge. On a closed platform, you're stuck with yesterday's intelligence. On blueBriX, you swap the agent — not the platform.
We move you from buying a tool (which depreciates as contracts evolve) to buying an architecture (which appreciates as new, better agents enter the market). Your VBC investment grows with the ecosystem.
Deploy a specialist risk-adjustment agent for HCC coding and a partner agent for prior authorization — both governed by your VBC contract rules inside the blueBriX Trust Engine.
Update the contract ruleset in the Governance Engine. Every agent — native or third-party — is now validated against the new model automatically. No re-implementation.
Adapt in daysUnplug the old agent, plug in the new one. Your care gap workflows keep running — zero workflow re-build, zero data migration, zero disruption to ongoing VBC programs.
Swap in minutesYour blueBriX architecture is more valuable than on day one. Every new AI model that enters the VBC market is an option for your organization — not a threat to your existing stack.
Architecture appreciatesReal objections, honest answers.
General healthcare AI is built for the average patient and the average workflow. Value-based care is not average — it requires condition-level specificity for HCC coding, real-time gap detection against specific HEDIS measure definitions, and contract-specific validation logic that differs by payer.
A generic coding bot that suggests "Diabetes" where the contract requires "Type 2 Diabetes with Stage 3 CKD" costs you capitation revenue every cycle. blueBriX's Governance Layer encodes your specific contract terms, payer models, and quality measure specifications — so AI suggestions are always evaluated against your actual VBC obligations, not a generic standard.
The most valuable thing about blueBriX isn't any individual agent — it's the platform. Getting your longitudinal patient data unified, your VBC contract rules encoded in the Governance Engine, and your workflows running through the execution layer is the hard implementation work. That takes time, and it's the foundation everything else runs on.
Organizations that start the platform now with pre-validated partner agents will be able to activate native agents the week they launch — with zero re-implementation. Those that wait will spend 6–12 months on platform setup before they see any AI-driven VBC value.
EHR-native AI is built around the EHR's data model and is governed by the EHR vendor's roadmap. It's a strong option if you're fully committed to one EHR's ecosystem and their VBC AI capabilities match your contract requirements.
blueBriX is designed for organizations that need to plug in best-of-breed AI that their EHR doesn't offer natively, manage multiple EHRs across a practice, or retain the flexibility to swap AI models as the VBC landscape evolves. EHR governance governs EHR workflows. blueBriX governance governs any agent on any workflow, including across multiple EHR environments.
During implementation, your VBC contract terms — payer-specific HCC models, shared-savings thresholds, HEDIS measure specifications, quality reporting windows, and CMS requirements — are configured into the blueBriX Trust Engine as a ruleset.
Every agent output passes through this ruleset before execution. An HCC code suggestion is checked against your specific payer's model. A care gap action is checked against the right HEDIS measure definition. A claim is checked against the contract's billing rules. The result is a full audit trail showing exactly which contract rule validated each AI-driven action — defensible in any payer audit.
For a first VBC workflow (HCC Coding or Prior Authorization with a pre-validated partner agent), most organizations are live within 4–8 weeks of contract signature — assuming FHIR-based EHR connectivity and contract rule configuration are completed upfront.
Our goal is value within 90 days on at least one workflow. If we can't get you to a measurable VBC outcome in that timeframe, we haven't done our job. We'll give you a specific deployment timeline in the discovery call based on your current stack, payer mix, and VBC contract structure.
Yes — this is a core design principle. If your organization has already invested in a specific AI tool for risk adjustment, documentation, or patient engagement, you can connect it to blueBriX through the governed API layer (BYOA — Bring Your Own Agent).
Your existing agent gains access to the unified longitudinal patient record and full-stack VBC workflow execution, while the blueBriX Trust Engine applies the same VBC contract validation it applies to every other agent on the platform. You don't lose your existing investment — you amplify it.
The platform is live. Partner agents are ready to deploy. Let's start with the VBC workflow that moves the needle most for your organization — and build from there.
Schedule a VBC demo