Meet PopHealth AI—your proactive patient risk-tracking agent.
PopHealth AI gathers and organizes scattered patient data—claims, check-ins, and prescription histories—into a single, unified view. Using BigQuery ML, it automatically tracks invisible risk factors like missed appointments, test result trends, and social barriers to forecast who is at high risk for hospital readmission in the next 90 days.
Once the highest-risk group is identified, our AI agent doesn't just raise an alarm—it drafts a personalized outreach plan, such as booking a follow-up visit or adjusting a medication schedule. These plans go straight to your care managers' daily worklists via Looker.
The result? Teams can reach out to vulnerable patients early, preventing crises and reducing hospital admissions—all before an emergency happens.
📉 Reduces preventable admissions by 25% –
Proactively manage high-risk patients to keep them healthy at home.
🔍 Smart Risk Analytics –
BigQuery ML predicts 90-day hospital readmission risks using complete patient histories.
📋 Actionable Care Outreach
Care managers receive auto-generated care plans directly in their daily Looker dashboards.