Complex patients deserve complete data
Your patients do not have one chronic disease — they have four. Diabetes with CKD, hypertension, and depression. CHF with COPD and atrial fibrillation. The average internist's panel carries higher acuity than any other primary care specialty, which means more care gaps per patient, more HCC codes to capture, and more financial risk in value-based contracts.
Glance manages the complexity. Multi-condition care gap views, polypharmacy medication adherence tracking, and risk stratification that accounts for the full burden of disease.
Schedule a Demo See FeaturesBuilt for the complexity internists manage
When a single patient has five chronic conditions, you need a tool that shows the full picture — not five separate disease-specific views.
Multi-Condition Care Gap Tracking
See all open care gaps for a patient in one view, regardless of which chronic condition drives each gap. Diabetes A1c, nephropathy screening, retinal exam, BP control, statin adherence, depression screening — all in one place. Prioritize by clinical urgency and financial impact.
HCC Coding for Complex Patients
Patients with multiple comorbidities have the most HCC codes to capture — and the most to lose if conditions are not recaptured annually. Glance surfaces suspected conditions, tracks year-over-year coding patterns, and flags patients with RAF score drops that suggest missed diagnoses.
Medication Adherence (PDC)
Track Proportion of Days Covered across all medication classes — statins, antihypertensives, oral diabetes medications, antidepressants. For your complex patients on 8-12 medications, identify which specific drugs are falling below the 80% PDC threshold and when.
Risk Stratification
Segment your panel by acuity. Identify rising-risk patients — those with worsening lab trends, increasing utilization, or new diagnoses — before they become high-cost. Allocate care management resources where they will have the greatest impact on outcomes and cost.
Financial Analytics
Your complex patients drive higher PMPM costs but also generate higher capitation payments when coded accurately. Track total cost of care by patient cohort, identify where spend is concentrated, and project shared savings based on care gap closure rates and utilization trends.
Clinical workflows for complex panels
Internal medicine workflows center on managing the whole patient, not individual diseases in isolation.
Pre-Visit Complexity Review
Before every visit, see the patient's full problem list, open care gaps, medication adherence scores, recent utilization (ED visits, hospitalizations, specialist encounters), and pending HCC recapture opportunities. Turn a 15-minute visit into a high-impact encounter.
Reference Range Context
Lab results interpreted in the context of the patient's conditions. An eGFR of 55 means something different in a 68-year-old diabetic with known CKD than in a new patient. Glance provides condition-aware reference ranges and trends, not just normal/abnormal flags.
Specialist Coordination
Track referral patterns across your panel. See which specialists your patients are seeing, what claims are being generated outside your practice, and where the total cost of care is being driven. Coordinate care without duplicating orders or missing follow-through.
EHR Integration via SMART on FHIR
Launch Glance from within your EHR during any patient encounter. All care gaps, HCC opportunities, and medication adherence data available at the point of care without switching systems or logging in separately.
