The Chronic Disease
Intelligence Layer
for every EMR.
Five specialized AI agents. Polyconditions. One platform that lives inside the EMR your clinicians already use — turning fragmented care into continuous, CMS-aligned intelligence.
US chronic disease burden
of Medicare beneficiaries have 2+ chronic conditions (CMS)
of chronic-disease time is spent outside the clinic
RPM + CCM + APCM + BHI billing model — full economics in data room
The problem
Chronic care is the spend.
And the system can't see it.
Polyconditions — atrial fibrillation, hypertension, type 2 diabetes, heart failure, CKD, COPD, coronary artery disease, obesity, and hyperlipidemia — drive the majority of a $4.1 trillion spend. Patients live with them 99% of their lives, outside the clinic and outside the EMR. AlfredAI is the intelligence layer that operates that 99%.
AlfredAI is the intelligence layer that sits inside Epic, Oracle Health, athenahealth, eClinicalWorks, NextGen, and Elation — quietly continuous between visits, fluent in CMS quality measures, and accountable to the physician who signs the chart.
Five agents · one team
A clinical team, in software.
Educator
Plain-language patient education tuned to literacy, language, and condition stage.
Historian
Longitudinal chart synthesis across visits, labs, devices, and notes.
Coach
Between-visit behavioral nudges and adherence support.
Strategist
Care-plan optimization aligned to CMS quality measures.
Architect
Population-level intelligence and risk stratification for the panel.
EMR-native
Embedded where clinicians already work.
Physician-led
Designed and clinically governed by practicing physicians — not retrofitted from generic LLMs.
Multi-agent reasoning
Specialized agents collaborate the way clinical teams do, with auditable reasoning at every step.
CMS-aligned revenue
Codifies CCM, PCM, RPM, BHI workflows — turning continuous care into reimbursable revenue.
Bring the intelligence layer to your panel.
See AlfredAI inside your EMR with a 20-minute demo for clinical and operational leaders.
Request a demo