This Startup Streamlines Well being Care Referrals

When medical doctors within the United States refer sufferers to specialty or post-acute medical care akin to bodily remedy or long-term nursing care, almost half by no means full the method of discovering assist. Referrals stall partly as a result of supplier directories are outdated, insurance coverage protection is unclear, and far coordination nonetheless depends on cellphone calls and faxes.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 private knowledge. As a substitute of presenting a protracted listing of suppliers, a lot of whom wouldn’t be 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 usually are not conveniently situated.

The startup’s platform serves people in search of care in addition to well being 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, but it surely plans to broaden protection nationwide.

Noah, a Ph.D. candidate who joined IEEE in 2022 as a scholar member, encountered the referral downside 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 accessible, and was close to his residence required hours of cellphone calls and searches via inaccurate supplier lists, he says.

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

A damaged referral system

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

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

She and Noah quickly realized they have been coping with the identical damaged system from reverse sides. Present analysis on referral lapses supported their expertise. Major care physicians typically ship referral notes—analogous to prescriptions—that listing 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 method that permits suppliers at nursing properties and rehab services to entry the data.

Physicians typically submit their options for ongoing remedy in sections of a affected person’s digital well being data, however suppliers at post-acute services don’t have entry to these due to medical privateness 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 College of Denver laptop science division, the place his tutorial work focuses on privateness and safety in digital techniques.

He’s Carenector’s chief government and technical lead, overseeing the system’s design, making technical selections, and assembly with buyers.

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

Starting an organization whereas a scholar, 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 workforce 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 knowledge engineering fields.

Changing cellphone calls with digital matching

By utilizing standardized digital info shared amongst medical services, Carenector eliminates the necessity for employees to make cellphone 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 largest challenges for Noah is getting correct knowledge on which providers 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 info in the US will not be centralized,” he says, “and insurance coverage supplier directories are sometimes unsuitable or outdated.”

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

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

This structured knowledge helps Carenector consider plan standards, supplier capabilities, geographic availability, and high quality indicators to assist referral decision-making. The corporate standardizes and organizes the data inside its personal system structure 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 knowledge is up to date periodically, Carenector dietary supplements it with extra structured knowledge sources and referral final result analytics to higher perceive plan acceptance patterns. Room availability info comes straight from collaborating services, that are answerable for updating their standing inside Carenector’s system.

Whether or not referrals succeed or fail gives important suggestions, Noah says. When referrals to particular services repeatedly go uncompleted—which 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 chance of that facility being thought of for comparable circumstances. Amenities that persistently settle for and full referrals are ranked preferentially.

Apps for sufferers and services

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

The affected person app helps customers find applicable well being care providers for gratis. Customers can seek for care by service kind, ZIP code, or insurance coverage firm with out creating an account. They obtain an inventory of matching services that may be shared through clipboard or despatched by electronic mail to themselves or members of the family..

Within the facility app, clinicians enter the prognosis, rehabilitation wants, gear necessities, insurance coverage kind, and placement with out sharing personally identifiable affected person info. 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.

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

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

“Privateness 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 knowledge to keep away from changing into an information 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 Well being Insurance coverage Portability and Accountability Act (HIPAA) necessities. The HIPAA regulation units requirements meant to guard delicate affected person info from unauthorized disclosure.

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

Enterprise mannequin and measured enlargement

Carenector’s development plan, Noah says, is strategic. Relatively 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 digital well being file techniques akin to Epic and Cerner—whereas additionally growing visibility for care services in underserved and distant areas. The plan, he says, is to assist 1000’s of facility suggestions per day, in contrast with the roughly 200 each day facility suggestions it presently generates. Noah additionally seems ahead to the broader adoption of APIs that enable care coordination and facility discovery to happen straight inside scientific workflows.

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

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