--- title: "Population health governance and risk cohorts | Arbol AI" description: "Arbol brings together the EHR, labs and payer data, sorts every patient into risk cohorts and tells your team who to reach first, and why." url: https://www.getarbol.com/en/governance/ lang: en alternates: es: https://www.getarbol.com/gobernanza/ --- # Know who to reach first, and why. Arbol governance brings together each patient’s EHR, labs, immunizations and claims data, places them in their risk cohorts, anticipates their risk and alerts the physician when something changes. For whoever is accountable for the health of a population. [Book a demo](https://cal.com/tomas-giraldo-pdfbl9/30-min-arbol-ai-demo) This week’s priorities 1. **1** **George M., 67** Rising creatinine, lives alone, and a foot wound that won’t heal. *Alert to the physician · today Nurse home visit* 2. **2** **Ashley R., 29** Positive pregnancy test and no first prenatal visit yet. *Call · today Prenatal visit · Thursday* 3. **3** **Luis P., 58** Hypertension, smokes, and 14 months without a lipid panel. *Call · this week* 4. **4** **Sophia T., 1** Due for her 15-month vaccines. *Text to her mom · vaccines Saturday* ## Your population, in cohorts. 1. Arbol reads the EHR, the labs and the payer’s claims data, and places every patient in their cohorts: cardiovascular risk, diabetes, kidney disease, prenatal, and whatever cohorts your team defines. 2. Every cohort has its own criteria and its own quality measures. Cardiovascular risk · criteria - Ages 40 to 75 - Hypertension or diabetes - Smoker - BMI of 30 or more Quality measures · example - Blood pressure controlled **68%** - Lipid panel this year **54%** - Smokers counseled **31%** 3. And every patient moves when their story 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 their own, none of them looks urgent. Together they say George should be first on the list this week. 1. EHR · March Type 2 diabetes since 2016. HbA1c of 8.9%. 2. Lab · August Creatinine 1.6 mg/dL. In March it was 1.2. 3. Social needs screening · August 67 years old. Lives alone. 4. Follow-up call · September “The sore 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 goal. - He lives alone and hasn’t been back for a visit. - He has a foot wound that won’t heal. 1. Alert his physician, today. 2. Internal medicine visit this week. 3. Nurse home visit for wound care. 4. Follow-up call in seven days. ## Same budget. Two endings. 1. Under a population contract, you get the same amount every month. Without governance, it goes to ER visits and hospital stays that could have been prevented. 2. With governance, you spend a little more on timely checkups and screenings, and complications come down. The math works. Illustrative example. Your numbers come from your own contracts. What your contract pays each month for your population - Visits and checkups 30% 33% - Labs and screenings 12% 16% - Prescriptions 25% 24% - ER visits 18% 9% - Hospital stays 27% 12% Spent 112%: a 12% loss Spent 94%: a 6% margin ## Every call has a purpose. Your organization’s assistant (Monica, in this example; you pick the name) calls and texts every patient in the cohort about what they’re missing, and what they answer goes back to their chart. 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 - Monica Good morning, Mr. Parker. This is Monica from Northside Health, calling about your heart checkup. Are you still smoking? - Mr. Parker I’m down to three cigarettes a day. - Monica Thanks for telling us. Can I book your checkup with a lipid panel for Thursday? Smoking status updated in the chart · checkup booked 2. Prenatal · Text - Monica Hi Ashley, it’s Northside Health. Your pregnancy test came back. Have you had your first prenatal visit yet? - Ashley Not yet. - Monica I can book you with our nurse practitioner Thursday at 7:30 a.m. Does that work? First prenatal visit booked · week 9 3. Immunizations · Text - Monica Hi Ms. Taylor, Sophia is due for her 15-month vaccines. Does Saturday at 9:00 a.m. work? - Ms. Taylor Yes, Saturday. - Monica You’re all set. I’ll text you Friday with a reminder and what to bring. Vaccines booked · reminder on Friday ## What you see before it happens. Governance looks ahead: it puts 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. [About 9 in 10 adults with chronic kidney disease don’t know they have it. CDC, 2026.](https://www.cdc.gov/kidney-disease/php/data-research/index.html) 2. ### A test, a follow-up or a vaccine that’s overdue. 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 visit: together they raise the priority before a complication does, like an amputation. 4. ### A pattern that doesn’t fit. When lab results and the physician’s notes match the criteria for a rare disease, Arbol flags it for a specialist to review. This is Ámbar’s Clinical Council: it suggests to nursing and to physicians what to review, which cohort each patient belongs in, what to rule out and which risk factor is still missing from the chart, like smoking status. It doesn’t diagnose or change treatment: diagnosis and care decisions always belong to the physician. ## Capitation and shared savings, in plain words. In both, the provider carries the cost of a population getting sicker. That’s why prevention and timely follow-up are what make the contract work. A fixed amount per person, every month. ### Capitation A health plan pays the provider a fixed amount for each assigned member, every month, to cover a defined set of services. If the population stays healthier, the contract works; if it gets sicker, the provider absorbs the difference. A spending target, agreed in advance. ### Shared savings and risk contracts The provider and the payer agree on a spending benchmark for a population, with quality measures attached. Come in under the benchmark while meeting quality, and the provider shares in the savings; in two-sided contracts, it shares the losses too. ### Different names. Same work. The programs have different names, but the job is the same: someone is accountable for the health of a population, on a set budget, with measured quality. - Medicare Advantage Medicare pays private plans a monthly amount per member, and many plans pay their medical groups by capitation. - Medicare ACOs Accountable care organizations share in the savings, and in some tracks the losses, against a spending benchmark. - Medicaid managed care States pay managed care plans a monthly rate per enrollee, and the plans contract with provider networks. - Commercial plans Employer and individual health plans tie payment to cost and quality targets. - Bundled payments One price for a whole episode of care, like a joint replacement, shared across the providers involved. It’s no longer the exception: - [55% of eligible Medicare beneficiaries are in Medicare Advantage in 2026 (KFF)](https://www.kff.org/medicare/medicare-advantage-in-2026-enrollment-update-and-key-trends/) - [14.3 million Medicare beneficiaries receive care coordinated by an ACO in 2026 (CMS)](https://www.cms.gov/newsroom/fact-sheets/2026-medicare-accountable-care-organization-initiatives-participation-highlights) ## Who it’s for. - ### Medical groups and health systems In capitated, shared-savings or bundled-payment contracts. - ### Health plans That need to know who in their membership is at risk. - ### ACOs and value-based networks Accountable for cost and quality across a population. - ### Chronic care programs Cardiovascular, kidney, maternal health and high-cost conditions. ## Governance flags. The physician decides. Your clinical team defines the rules for every cohort. Arbol applies them every day, across your whole population, and keeps a record of who it alerted, who it called and what each patient said. ## 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 understand your operation. [Book a demo](https://cal.com/tomas-giraldo-pdfbl9/30-min-arbol-ai-demo) [Or talk to our team](https://www.getarbol.com/en/contact/) Built to **HIPAA** standards · A signed BAA before any patient data --- **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: