The layer between the visit and the outcome
Care plans don't fail in the exam room. They fail in between.
Every care plan has a clinician who wrote it and nobody who owns it between visits. TRK Health tracks what the practice and the patient committed to, catches what stalls, and measures whether the treatment worked.
Where care quietly goes missing
The imaging that never gets scheduled
An MRI is ordered at the visit. Two weeks later nobody has booked it, and nobody knows.
The referral that never lands
The referral goes out. The patient never arrives, or goes somewhere else, and the practice finds out months later, if ever.
The treatment nobody asks about
An injection, a new medication, a therapy course. Whether it worked is a question nobody owns until the next visit.
Each one costs the patient an outcome and the practice a patient. Under value-based contracts it also costs the payment tied to that outcome.
What changes
Value for everyone in the care plan
Practice leaders
- See the value of care under management, at risk and progressed
- Know where patients leak out of network, by source, payer and stage
- Keep the evidence value-based programs ask for, as the work happens
Clinicians
- One next action per patient, not a pile of tasks
- Outcomes per treatment, for this patient and across your panel
- AI drafts notes and suggestions; you decide what happens
Care teams
- A worklist of what is stuck and why, on both the practice and patient side
- Follow-up questions are scheduled with every treatment; patients who can’t be reached come back to a person
- Calls, messages and time logged where the work happens
Patients
- One short question at the moment it matters
- No app to download and no password to answer
- A clear view of what happens next in their care
How it works
One loop, for every episode of care
Six stages from the first visit to completed care, for any specialty. The clinical detail lives in the care plan; the loop stays the same.
- 01
Expect
Protocols set what should happen after each treatment: which measure, and when.
- 02
Track
Every commitment has an owner, a side (practice or patient) and a due date.
- 03
Detect
Plain rules over your data flag stalls, missing answers and results outside the expected range.
- 04
Act
The right person gets the next action. Every action is measured again.
Value-based care
The evidence programs ask for, kept as the work happens
Which patients qualify, and if not, which fact is missing. Enrollment and consent on file. Required measurements on schedule. Time logged month by month. Whether each target was met. TRK records the evidence; your biller confirms and bills.
Programs supported
- CMS ACCESS: musculoskeletal pain, cardio-kidney-metabolic disease, early risk, depression and anxiety
- Chronic and principal care management (CCM, PCM)
- Remote therapeutic and physiologic monitoring (RTM, RPM)
- MIPS quality reporting
Built to be trusted with patient care
Clinicians decide
AI drafts and suggests. It never makes a clinical decision or contacts a patient on its own.
Findings you can explain
Stalls and missing outcomes are detected by plain rules, not a black box, so every flag has a reason.
Access is recorded
Every view of patient information is logged to an audit trail that cannot be edited or deleted.
Secure sign-in
Multi-factor authentication for staff, with HIPAA-conscious design throughout.
Works alongside your EMR
TRK Health connects through SMART on FHIR, the standard used by Epic, Oracle Health (Cerner), athenahealth, NextGen, eClinicalWorks, Greenway and ModMed. Your team keeps charting where it already does.
See it with your own care plans
We'll walk through a few of your typical patients, between visits.