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Better Adherence Across the Patient Journey.

Turn evidence-based care plans into longitudinal programs that keep patients on track between visits, improving outcomes and reducing preventable complications at scale.

HIPAA Compliant
SOC 2 Certified
Active Care Programs
6 programs · 1,240 patients
● Live
ProgramPatientsAdherence
Diabetes Management
284
91%
Heart Failure
156
88%
Maternal Health
97
96%
COPD
203
84%
Hypertension
412
79%
Behavioral Health
88
71%
Population Adherence
On Track842
Needs Attention267
High Risk131
1,240 total patients
AI Recommendations
12
Patients overdue for check-in
6
Medication adherence risks
4
Patients require outreach

Built for Every Value-Based Care Model.

Subflow helps value-based care organizations improve patient adherence between visits through intelligent, automated longitudinal care programs, reducing complications, closing care gaps, and improving quality performance.

Health Systems

Scale longitudinal care programs across large patient populations without proportional staffing increases.

Accountable Care Organizations

Support ACO REACH and MSSP quality performance with continuous patient adherence between every visit.

Value-Based Care Organizations

Improve quality measures, close care gaps, and reduce total cost of care across attributed populations.

FQHCs & Community Health Centers

Extend care team capacity and improve health equity outcomes for underserved patient populations.

Rural Health Clinics

Bridge the gap between infrequent in-person visits with consistent, automated patient engagement.

Health Plans

Improve HEDIS scores, close care gaps, and support member health management at scale.

More Care Programs

Diabetes ProgramsHeart FailureCOPDHypertensionBehavioral HealthMaternal HealthWeight ManagementSmoking CessationCKDPopulation HealthCare ManagementRemote Monitoring

The Biggest Risk Happens Between Visits.

Most organizations communicate with patients. Few actively sustain patient adherence between appointments. When patients disengage, medications are missed, conditions worsen, and costly complications develop invisibly.

Patients Disengage Between Visits

Without continuous touchpoints, patients lose motivation, forget instructions, and drift from their care plan, often without the care team knowing until the next appointment.

Complications Go Undetected Until It's Too Late

Missed medications, worsening symptoms, and early warning signs are invisible to care teams without continuous patient monitoring between visits.

Programs Can't Scale Without Adding Staff

Sustaining patient adherence over months requires consistent patient contact. Without automation, scaling these programs means hiring coordinators proportional to patient volume.

From Care Plans to Continuous Adherence.

Every longitudinal care program begins with an evidence-based care plan. Subflow automates patient education, reminders, assessments, and follow-up, keeping every patient engaged and adherent between visits.

1

Define the Care Plan

Build evidence-based care plans for chronic conditions and longitudinal programs once, and deploy them at scale across your patient population.

  • Configure by condition and risk level
  • Digitize clinical protocols and milestones
  • Define adherence goals and escalation thresholds
2

Automate Longitudinal Engagement

Deliver education, medication reminders, check-ins, assessments, and PROs automatically, keeping patients connected to their care between every visit.

  • SMS-first patient engagement
  • Condition-specific education over time
  • Symptom check-ins and medication reminders
3

Measure Adherence & Outcomes

Track patient adherence across your population in real time, identify risk early, and guide care teams toward the patients who need intervention most.

  • Population adherence dashboards
  • AI-powered risk detection
  • Intelligent escalation workflows

Turn Clinical Protocols into Intelligent Care Plans.

Every chronic condition has a clinical protocol. Subflow transforms those protocols into configurable digital care plans that automate patient engagement, measure adherence, and keep every patient on track between visits.

Care Plan Builder
✓ Autosaved · 2m agoEnrolled
Diabetes Management
● ActiveEdited 2h ago
Evidence-Based·SMS + Email·12 touchpoints·78% avg adherence
Education
Treatment Overview
Medication Education
Nutrition Basics
Exercise Guidelines
Medication Management
Daily Medication Reminders
Refill Alerts
Dose Tracking
Insulin Protocol
Blood Sugar Tracking
Glucose Check-In Prompts
Reading Submission
Threshold Alerts
Communication
SMSEmailVoiceTiming Rules
AI Rules
IfGlucose > 180 mg/dLNotify Care Navigator
IfMedication missed > 2 daysEscalate Risk Score
Success Metrics
HbA1c ControlMedication AdherenceEngagement RateComplication Rate
Patient View↺ synced 12s ago
JK
0%adherence
James K.
Diabetes Management
Week 8 of 52 · 8 of 12 check-ins
Moderate Risk
EnrolledEducationWk 4HbA1cAnnual
Timeline Detail
Enrolled
Week 0 · done
Education Delivered
Week 2 · completed
Week 4 Check-In
Week 4 · completed
90-Day HbA1c Review⚠ Needs attention
Week 12 · due today
Annual Reviewupcoming
Week 52 · scheduled
AI Insight

Patient has completed 8 of 12 required check-ins. HbA1c lab review is due this week. Current adherence is trending slightly below program average.

Real Results. Real Healthcare Organizations.

Subflow is already helping healthcare organizations improve patient engagement, care coordination, and outcomes. These are outcomes from real customer deployments.

90%+
Patient Engagement & Adherence

Evidence-based care plans, personalized education, automated reminders, and two-way communication helped patients stay engaged throughout their care journey, improving adherence without adding staff workload.

Aggregate: Subflow longitudinal care deployments
99%
Patient Satisfaction (NPS)

Patients reported an exceptional care experience through personalized education, proactive communication, and continuous digital follow-up throughout their care program.

Powder River Surgery Center
74%
Reduction in Post-Operative Emergency Department Visits

Digital symptom monitoring, structured follow-up, and early intervention helped identify at-risk patients sooner, reducing unnecessary emergency department utilization after surgery.

Longitudinal care case study

Why Value-Based Care Organizations Choose Subflow

Most patient engagement platforms automate reminders. Subflow sustains patient adherence through intelligent, evidence-based longitudinal care programs.

01

Evidence-Based Care Plans

Subflow builds structured care programs for chronic conditions aligned to your clinical protocols, not generic patient engagement workflows.

02

Continuous Patient Adherence

AI continuously monitors patient adherence between visits, identifying patients who need intervention before missed medications become complications.

03

AI Population Monitoring

Real-time population dashboards give care teams visibility into adherence trends, care gaps, and risk across their entire patient panel.

04

Enterprise Healthcare Platform

HIPAA compliant, SOC 2 certified, FHIR native, and built for the regulatory and operational demands of value-based care organizations.

Ready to Improve Patient Adherence Between Every Visit?

See how Subflow transforms evidence-based care plans into intelligent longitudinal programs that sustain patient adherence, close care gaps, and improve outcomes at scale.

Explore the Platform