Agent Hive for healthcare

Decisions you can explain.

Bring claims, clinical data, quality measures and policy into one clear investigation. Your experts still make the call.

Map your workflow Explore the blueprint

Decision under reviewWhy did this score move, and where should the team look next?

ClaimsClinical dataQuality measureCMS publication

Agent HiveEvidence for this decisionSources attached

PolicyHistorical performanceProvider / member context

Finding ready to reviewWhat changed, which rule applied and when it matters.Human review required

See the whole case before deciding what to do.

The facts are usually spread across systems, documents and reporting years. Agent Hive brings the relevant pieces together without losing their source or version.

Evidence across many systems

Systems of record stay in place

ClaimsEvents and utilization
EHR / clinical dataWhere applicable
Quality measuresDefinitions and rates
CMS publicationsRules and methodology
Policies / guidelinesCurrent and prior versions
Historical performanceResults over time
Provider / member contextPermitted attributes

Agent Hive connects what matters

Definitions, dates and sources stay attached

MeasureDefinitionThresholdVersion historySource historyDependenciesQuestion to answer

CompareCalculateTraceCorrelateExplain

Agents do the legworkThey compare versions, run calculations and follow the source trail.
Experts check the findingQuality and operations teams review the evidence and assumptions.
The team decidesApprove the next step, ask for more evidence or stop.

No black-box answer. Reviewers can see how the conclusion was reached.

Start with a decision your team already has to make.

Choose work your experts know well. Agent Hive gathers the evidence and does the analysis, then hands the decision back to them.

Quality performance investigation

A score moved. Find out why.

See whether the change came from performance, a new threshold, a revised definition, a different weight or an updated methodology before the quality team responds.

TriggerUnexpected score movement
EvidenceMeasures, thresholds, methods, history
Agent legworkCompare, calculate and trace
Expert callQuality team confirms the cause
ResultA clear reason and next focus

Solution blueprint / technical reference

Healthcare Quality Intelligence Blueprint

A practical way to answer a deceptively simple question: why did this Medicare Advantage Star Rating change?

This shows how the workflow could work. It is not a customer case study or a completed deployment, and it makes no results claim.

Measure definition
Historical performance
Cut points
Methodology
Publication year
Contract context

Read the full blueprint

Illustrative reasoning trailExample values. No results claimed.

Measure performance71%Reported rate

Current rating3 starsCut point used

Next threshold75%4-star boundary

Gap4ppNot an outcome claim

Measurement periodWhen performance is earned

Publication and rating yearWhich methodology applies

What this could affectWhat the quality team should test next

Optional proof[Benchmark / evaluation result]Publish only after the evaluation method and result are verified.

Optional build detail[Agent Hive implementation detail]Confirm the implemented components before publishing.

Optional visual[Implementation screenshot]Add only a real, approved implementation image.

Healthcare changes the evidence, not the platform.

The same Agent Hive foundation supports quality, care-gap, regulatory and operational work. What changes is the data, rules and people involved.

Quality performanceCare-gap investigationRegulatory intelligenceHealthcare operations

One platform beneath every workflow

Enterprise Context
Bring the relevant data, measures, policies and regulatory versions together.
Agent Orchestration
Give research, calculation and evidence agents clear roles in the same investigation.
Evaluation and Improvement
Check answers and calculations against known cases before teams rely on them.
Governance and Deployment
Set permissions, approval steps, audit history and where the platform runs.

Managed

Let QpiAI run the application environment.

Your approved connectors and identity controls stay in place while QpiAI manages the platform.

Approved enterprise boundary

Healthcare sourcesPermissions preserved

Secure connectorsYour access rules apply

Managed Agent HiveAccess and audit controls

Questions healthcare teams ask early.

Most conversations start with four things: the decision, the evidence behind it, who reviews it and where the work can run.

Yes. Your clinical, claims, quality, policy and analytics systems remain the systems of record. Agent Hive connects to them through the permissions and interfaces you approve.