This Startup Streamlines Well being Care Referrals

When medical doctors within the United States refer sufferers to specialty or post-acute medical care resembling bodily remedy or long-term nursing care, practically 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 Referrals stall partly as a result of supplier directories are outdated, insurance coverage protection is unclear, and far coordination nonetheless depends on cellphone calls and faxes.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 acceptable care suppliers whereas defending their private knowledge. As an alternative of presenting a protracted listing of suppliers, a lot of whom wouldn’t be a superb match, the corporate’s referral platform makes use of AI to get rid of amenities that don’t meet the affected person’s rehabilitation wants, don’t settle for the affected person’s insurance coverage, or aren’t conveniently positioned.

The startup’s platform serves people searching for 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 amenities solely in Colorado, however it plans to increase protection nationwide.

Noah, a Ph.D. candidate who joined IEEE in 2022 as a pupil 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 by inaccurate supplier lists, he says.

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

A damaged referral system

The corporate took form when Noah linked along 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 amenities that bridge the hole between hospital discharge and the affected person’s skill to independently handle life’s day by day actions.

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

She and Noah quickly realized they had been coping with the identical damaged system from reverse sides. Present analysis on referral lapses supported their expertise. Main care physicians usually ship referral notes—analogous to prescriptions—that listing the affected person’s medical historical past and describe the wanted therapy.

Noah found that solely about one-third of the notes are transmitted in a means that permits suppliers at nursing properties and rehab amenities to entry the knowledge.

Physicians usually submit their recommendations for ongoing therapy in sections of a affected person’s digital well being information, however suppliers at post-acute amenities 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 govt 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 circumstances.

Starting an organization whereas a pupil, he has entry to college sources that many early-stage startups lack. He has participated within the college’s BaseCamp accelerator and obtained mentorship and enterprise planning assist.

The Carenector staff was assembled with the plan to scale up sooner or later with well being care compliance in thoughts. The group contains professionals from regulatory, authorized, and knowledge engineering fields.

Changing cellphone calls with digital matching

By utilizing standardized digital info shared amongst medical amenities, Carenector eliminates the necessity for workers 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 amenities—with insurance coverage plan standards and facility attributes resembling accessibility and repair capabilities.

One of many greatest challenges for Noah is getting correct knowledge on which companies amenities supply, which insurance coverage they settle for, and whether or not a affected person’s insurance coverage plan covers the therapy proposed by the referring doctor.

“Well being care info in america isn’t centralized,” he says, “and insurance coverage supplier directories are sometimes incorrect or old-fashioned.”

To handle that, Carenector incorporates publicly accessible datasets from the U.S. Facilities for Medicare & Medicaid Providers (CMS), together with plan attributes, service areas, high quality rankings, 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 knowledge 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 immediately from collaborating amenities, that are chargeable for updating their standing inside Carenector’s system.

Whether or not referrals succeed or fail gives vital suggestions, Noah says. When referrals to particular amenities repeatedly go uncompleted—that means the affected person doesn’t obtain the advisable care from the supplier—Carenector’s AI-driven matching algorithm adjusts to that sample and reduces the probability of that facility being thought-about for comparable instances. Services that constantly settle for and full referrals are ranked preferentially.

Apps for sufferers and amenities

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

The affected person app helps customers find acceptable well being care companies for gratis. Customers can seek for care by service sort, ZIP code, or insurance coverage firm with out creating an account. They obtain an inventory of matching amenities 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, tools necessities, insurance coverage sort, 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.

Services that use the app pay Carenector a flat charge 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 turning into an information repository. Though its function is proscribed 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 cut back the gathering and publicity of delicate info wherever attainable.

Enterprise mannequin and measured enlargement

Carenector’s development plan, Noah says, is strategic. Somewhat than scaling quickly, he says, he’s trying 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 amenities, insurers, employers, and main digital well being report techniques resembling Epic and Cerner—whereas additionally growing visibility for care amenities in underserved and distant areas. The plan, he says, is to assist hundreds of facility suggestions per day, in contrast with the roughly 200 day by day facility suggestions it presently generates. Noah additionally appears ahead to the broader adoption of APIs that enable care coordination and facility discovery to happen immediately inside medical workflows.

He says he sees his startup as a method 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.”