How It Works
From Referral to Results
A step-by-step look at how Vital Health Rural brings specialty care to your community — from day one deployment through sustained revenue and clinical outcomes.
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1
Partnership Launch
Vital deploys everything needed to start — at zero cost to your organization. Our team handles all setup, integration, and training so your staff can focus on patients from day one.
- Dedicated care managers deployed on-site or embedded virtually in your team
- Full technology stack provisioned — no purchasing or IT procurement required
- EHR integration via FHIR-standard APIs — compatible with Epic, Athena, Cerner, and others
- Staff orientation and workflow training completed before first patient enrollment
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2
Patient Identification & Enrollment
Vital's AI analyzes claims and EMR data to surface unmanaged autoimmune patients in your panel who are falling through the gaps — then activates multiple enrollment pathways.
- Claims and EMR signal analysis identifies patients with unmanaged or under-treated autoimmune disease
- PCP-initiated referral with care manager follow-up within 24 hours
- Patient self-referral option via community outreach materials
- Community screening campaigns coordinated with your team for proactive identification
68% of flare events go undocumented without proactive monitoringSignal Identification
Unmanaged RA · Positive RF FlaggedLupus SLE · No specialist in 18 mo FlaggedFibromyalgia + Joint Pain EnrolledPsoriatic Arthritis · Prior auths lapsed Flagged -
3
Specialist Engagement
Enrolled patients connect with board-certified rheumatologists through multiple touchpoints — all without leaving their community or waiting months for an appointment.
- e-Consult with specialist rheumatologist within 24–48 hours of enrollment
- Full tele-visit scheduled within days — not months
- Co-visit model: specialist joins the PCP's appointment virtually in real time
- In-person rounding specialist visits at your facility on a regular cadence
24–48 hr e-Consult turnaround vs. 6–12 month specialist wait
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4
Co-Promotion
Broad co-promotion to rural primary care physicians and patients. Building awareness of available specialty care services in the community.
- Outreach campaigns to local PCPs introducing available rheumatology and specialty services
- Patient-facing community awareness materials distributed through partner clinics
- Co-branded communications reinforcing your organization's expanded specialty offering
Community Outreach
PCP network briefings and specialist introductionsPatient-facing awareness materials at clinicCo-branded community communications -
5
Longitudinal Care & Intelligence
Between appointments, Vital's platform continuously monitors each patient's disease activity — catching flares early and feeding clinically validated data back to the care team.
- Patient downloads the Ease app and completes a 30-second daily check-in from home
- Validated clinical instruments: RADAI-5, RAPID3, RAID, and PROMIS-4 delivered through the app
- AI synthesizes FHIR records, lab trends, medication history, and live patient-reported data
- Captures 68% of flare events that would otherwise go undocumented between visits
- Care manager reviews AI-generated summaries and escalates as needed
Ease App — Daily Check-In
Today's RAPID3 Score14.2Moderate disease
activity — up from 11.8⚠ Flare signal detected — care manager notifiedPROMIS-4 Pain: 3.2 · Sleep disruption: moderate · Fatigue: high -
6
Pharmacy & Affordability
Vital's pharmacy infrastructure removes the two biggest barriers to specialty medication adherence: prior authorization delays and out-of-pocket cost. Patients receive their medications — reliably, affordably, at home.
- AI-assisted prior authorization with rapid turnaround — up to 3 days prior auth turnaround vs. the 23-day industry average
- Lowered average co-pay for enrolled patients through manufacturer assistance programs
- Medications delivered directly to the patient's home
- MTM (Medication Therapy Management) pharmacist reviews prevent adverse interactions and optimize adherence
Up to 3 days prior auth turnaround vs. 23-day industry average
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7
Ongoing Intelligence & Revenue
Revenue flows from month one. Your clinical team receives structured intelligence reports while Vital's billing infrastructure automatically captures every eligible care management code.
- Monthly clinical reports delivered to PCPs showing disease activity trends per patient
- Automated CPT code generation for RTM, PCM, CCM, RPM, PIN, and BHI billing
- Revenue flows to your organization beginning in month one of deployment
- Quarterly partnership reviews with outcome benchmarks and growth planning
- Annual population health summary for quality reporting and grant documentation
RTM PCM CCM RPM PIN BHIRevenue Codes
RTM (Remote Therapeutic Monitoring) BilledPCM (Principal Care Mgmt) BilledCCM + RPM + BHI BilledTotal (per 100 patients) Meaningful monthly revenue
At a Glance
What Vital Brings. What You Keep.
The Vital model is designed so your organization sees the benefit with zero additional burden.
What Vital Provides
- Care managers (embedded or virtual)
- Rheumatology specialist network
- Technology platform & Ease app
- AI-assisted prior authorization with rapid turnaround
- AI-powered clinical intelligence
- Billing code generation and submission support
- FHIR-based EHR integration
- Quarterly partnership reviews
What You Gain
- Meaningful monthly revenue per 100 patients
- Specialty care access without hiring or capital outlay
- Patient retention — no more urban transfers
- $0 medication co-pay for enrolled patients
- 68% more flare events detected and managed
- Monthly clinical intelligence reports
- Improved quality scores and HEDIS measures
- Population health data for reporting
- Stronger patient-PCP relationships
Ready to Start
Bring This to Your Community
The deployment process takes one week. Revenue begins in month one. Your community gets subspecialty access it has never had. There is no cost to partner.