--- title: "Health governance and risk management | Arbol AI" description: "Arbol brings together the health record, labs and insurer data, places every patient in their risk cohort and tells you who to see first, and why." url: https://www.getarbol.com/en/governance/ lang: en alternates: es: https://www.getarbol.com/gobernanza/ es-CO: https://www.getarbol.com/colombia/contratos/ --- # Know who to see first, and why. Arbol governance brings together each patient’s health record, labs, vaccinations and insurer data, places them in their cohorts, anticipates their risk and alerts the physician when something changes. For whoever answers for the health of a population. [Book a demo](https://cal.com/tomas-giraldo-pdfbl9/30-min-arbol-ai-demo) A real figure: **3,500+** patients prioritized at a single client. This week’s priorities 1. **1** **Jorge M., 67** Rising creatinine, lives alone, and a foot wound that won’t heal. *Alert to the physician · today Nurse visit* 2. **2** **Ana R., 29** Positive pregnancy test and no first prenatal checkup. *Call · today Prenatal checkup · Thursday* 3. **3** **Luis P., 58** Hypertension, smokes, and 14 months without a lipid panel. *Call · this week* 4. **4** **Sofía T., 1** Missing her 18-month vaccine. *WhatsApp to her mom · vaccine on Saturday* ## Your population, in cohorts. 1. Arbol reads the health record, the labs and the insurer’s data, and places every patient in their cohorts: cardiovascular risk, diabetes, kidney disease, pregnancy, and any your team defines. 2. Every cohort has its own criteria and its own indicators. Cardiovascular risk · criteria - Ages 40 to 75 - Hypertension or diabetes - Smokes - BMI of 30 or more Indicators · example - Blood pressure controlled **68%** - Lipid panel this year **54%** - Smokers counseled **31%** 3. And every patient changes cohort when their history changes. With a reactive HIV result, the nurse and the physician are alerted that same day, and the patient starts on their new care pathway. ## The signals add up. Arbol sees them together. On its own, none of them looks urgent. Together they say Jorge should be first on the list this week. 1. Health record · March Type 2 diabetes since 2016. HbA1c of 8.9%. 2. Lab · August Creatinine of 1.6 mg/dL. In March it was 1.2. 3. Patient profile · August 67 years old. Lives alone. 4. Follow-up call · September “The wound on my foot still hasn’t healed.” **Priority 1** Kidney and diabetic foot risk - His creatinine rose by a third in five months. - His HbA1c is above target. - He lives alone and hasn’t been back for a checkup. - He has a foot wound that won’t heal. 1. Alert his physician, today. 2. Internal medicine appointment this week. 3. Nurse visit for wound care. 4. Follow-up call in seven days. ## Same budget. Two endings. 1. Under a population contract, you receive the same amount every month. Without governance, it goes to emergency visits and hospital stays that could have been prevented. 2. With governance, you invest a little more in timely checkups and tests, and complications come down. The math works. Illustrative example. Your figures come from your contract’s technical note. What you receive each month for your population - Visits and checkups 30% 33% - Tests 12% 16% - Medications 25% 24% - Emergency visits 18% 9% - Hospital stays 27% 12% Spent 112%: a 12% deficit Spent 94%: a 6% margin ## Every call has a purpose. Your institution’s assistant (Mónica, in this example; you choose the name) calls and messages every patient in the cohort about what they’re missing, and what they answer goes back to their record. Your team asks Arbi, the internal agent, for the list: “Who in the cardiovascular cohort hasn’t had a lipid panel this year?” 1. Cardiovascular risk · Call - Mónica Good morning, Luis. This is Clínica Norte, calling about your heart checkup. Are you still smoking? - Luis I’m down to three cigarettes a day. - Mónica Thanks for telling us. Shall I book your checkup with a lipid panel for Thursday? Smoking status updated in the record · checkup booked 2. Pregnancy · WhatsApp - Mónica Hi, Ana. This is Clínica Norte: your pregnancy test result is in. Have you had your first prenatal checkup yet? - Ana Not yet. - Mónica I can book you with the head nurse on Thursday at 7:30 a.m. Does that work? First prenatal checkup booked · week 9 3. Vaccination · WhatsApp - Mónica Hi, Marta. Sofía is due for her 18-month vaccine. Does Saturday at 9:00 a.m. work? - Marta Yes, Saturday. - Mónica You’re all set. On Friday I’ll remind you of the appointment and what to bring. Vaccine booked · reminder on Friday ## The technical note, current. No waiting for the close. Activity by activity, Arbol compares what’s been done with what was agreed, reaches the patients still missing and keeps the record that backs every service. An example technical note, mid-period **487 services left to reach the target.** 1. Hypertension 89% · target 85% On track 2. HbA1c 68% · target 80% 311 missing · Arbol reaches 298 patients 3. Prenatal 93% · target 90% On track 4. Kidney risk 58% · target 75% 176 missing · Arbol reaches 171 patients 5. Diabetic foot 74% · target 70% On track Every service is logged in the health record with its time and outcome: material for quality reviews and audits. A real figure: **3,250+** services caught before the close, at a single client. ## What shows before it happens. Governance looks ahead: it brings together what the lab says, what the physician wrote and what the patient told us. 1. ### A creatinine that keeps rising. Arbol compares every result with the one before and alerts the physician when kidney function gets worse. 2. ### A test, a checkup or a vaccine still pending. What the physician ordered and never happened shows up in time, with the call to book it. 3. ### Risks that add up. Diabetes, living alone and a missed checkup: together they raise the priority before a complication arrives, such as an amputation. 4. ### A pattern that doesn’t fit. When the lab results and the physician’s notes match the criteria for an orphan disease, Arbol flags it for the specialist to review. This is Ámbar’s Clinical Council: it recommends to nursing and medicine what to review, which cohort each patient belongs in, what to rule out and which risk factor is still missing from the record, such as smoking. It doesn’t diagnose or change treatment: diagnosis and care decisions always belong to the physician. ## PGP and capitation, in plain words. In both models, the provider receives the same amount whether its population gets sick or not. That’s why what makes the contract pay off is prevention and timely follow-up. A fixed amount per person, every month. ### Capitation The insurer pays the provider a fixed amount for each assigned person, every month, to cover a set of services. If the population gets sick less, the contract pays off; if it gets sick more, the provider absorbs the difference. A global amount, agreed in advance. ### Prospective global payment (PGP) A global amount is agreed in advance to care for a population, or a group of patients with one condition, over a set period. It is calculated with a technical note (how many services are expected and what each one costs) and carries targets and outcome indicators. [The full guide: what PGP and capitation are and how to manage them](https://www.getarbol.com/en/colombia/pgp-and-capitation/) ### Different names. Same work. Health systems across the region are financed in much the same way: someone answers for the health of a population on a defined budget. - Colombia Capitation and prospective global payment (PGP) between EPS (insurers) and IPS (providers) - Chile Per-capita payment for primary care and DRG payment in public hospitals - Peru Capitated payment from SIS, the public health insurer, at the primary care level - Mexico Package contracts and agreements with insurers - Costa Rica Management agreements between the CCSS, the social security fund, and its health areas - United States Capitation in Medicare Advantage and accountable care organizations (ACOs) ## Who it’s for. - ### IPS and provider networks With population contracts, PGP, capitation or packages. - ### Insurers and EPS That need to know who in their population is at risk. - ### Prepaid health plans That want to see costs coming before they arrive. - ### Chronic care programs Cardiovascular, kidney, maternal and perinatal, and high-cost. ## Governance flags. The physician decides. The rules come from your contract, from clinical practice guidelines and from your institution’s protocols, and your clinical team approves them. Arbol applies them every day, across your whole population, and keeps a record of who it alerted, who it called and what each patient answered. ## Let’s look at your cohorts in Arbol. A 30-minute demo: your population, your contracts and the cohort worth starting with. Governance is quoted once we know your operation. [Book a demo](https://cal.com/tomas-giraldo-pdfbl9/30-min-arbol-ai-demo) [Message us on WhatsApp](https://wa.me/573185230045?text=Hi%2C%20I%27d%20like%20to%20see%20Arbol%20governance%20for%20my%20population.) Live in **Colombia** · Built for Latin America --- **Arbol AI** — AI agents for clinics and healthcare providers: they answer and reach patients by phone, WhatsApp, SMS, email and web chat, book their appointments 24/7 and keep a record of every conversation. - Original page: - Book a demo: · Pricing: - Agent index: · Support: