AI Care Team · Type 2 Diabetes

Your AI Care Team forType 2 Diabetes

Automate glucose and medication follow-up between visits, catch adherence gaps before they become ER visits, and unlock APCM revenue—without adding staff.

Try the Demo
Designed for HIPAA Compliance
Fasting Glucose — Last 14 Days
70–130 mg/dL target range● Flagged reading → outreach triggered
Riley

Let’s talk about that reading—how are you feeling?

“A little tired, skipped breakfast.”

The Problem

The Type 2 Diabetes Care Gap Is a $413 Billion Problem

More than 17 million ER visits a year list diabetes as a contributing diagnosis. The capacity to catch these patients between visits does not exist under current workflows.

45%

of patients never reach their A1C goal

Poor adherence is the leading driver: 47% of patients discontinue T2D therapy entirely within a year, often between visits when no one is watching.

38M+

Americans live with Type 2 diabetes—90–95% of all diagnosed diabetes, climbing to 28.8% of adults 65+.

$412.9B

Spent treating diabetes in the US every year—2.6x the cost per patient of non-diabetic care.

A one-point drop in a patient’s medication adherence is associated with a 20.4% jump in ER visits and a 20.9% jump in hospitalizations. Quarterly office visits can’t catch that in time—continuous outreach can.

How It Works

Infrastructure, Not Tools

Continua doesn’t replace your team—it multiplies their capacity to manage your highest-risk, highest-volume panel.

01

AI Pre-Processing

Voice and SMS AI agents check in between visits—logging glucose readings, reconciling metformin, GLP-1, and insulin regimens, and screening for cost-related non-adherence.

02

Human Validation

Your Care Coordinator reviews the AI summary, flags A1C or adherence red flags, and approves—in minutes.

03

Compliant Billing

Generates a billable, audit-proof encounter. You sign and bill APCM codes (G0556–G0558).

Clinical Evidence

Backed by the Clinical Evidence

Continuous outreach between visits isn’t a nice-to-have—it’s clinically validated to move the outcomes that matter.

6-Month Remote Monitoring Study
8.1%
Before
7.1%
After 6 months
Average A1C fell a full percentage point over six months of remote, algorithm-driven outreach.

−0.48%

Average HbA1c drop from SMS follow-up alone—up to −1.15% combined with voice, in high-risk populations.

72%

Less documentation burden—clinicians save an average of 3.3 hours a week.

95%+

Sustained patient engagement, voice + SMS combined—reaching patients single-channel tools miss.

Proactive, algorithm-driven outreach programs report up to 45% fewer urgent care and ER visits by catching metabolic deterioration before it becomes an acute event.

For Your Care Team

Patient outcomes come first—but Riley’s outreach also frees your Care Coordinators from hours of manual follow-up (72% less documentation, ~3.3 hours saved a week) and generates a billable, audit-proof encounter you sign and bill under APCM codes G0556–G0558.

The Economic Engine

Built for the 2025 Medicare Physician Fee Schedule, where complexity-based reimbursement rewards the comorbidities that come standard with a Type 2 diabetes panel.

How Much Revenue Is Your Diabetes Panel Missing?

Drag the slider to match your APCM-eligible T2D patient count.

50

hrs saved / mo

$12,400

per month

$148,800

per year

Based on APCM (G0556–G0558) avg. reimbursement @ $62/patient/month. 20 min manual → 5 min with Continua.

Built for 2025 Billing

T2D rarely travels alone—it clusters with hypertension, CKD, and hyperlipidemia, so most panels clear Medicare’s complexity thresholds without extra work.

G0556Level 1
~$15/mo

Rising-risk patients with one or fewer chronic conditions—like early-stage T2D—now billable for the first time under APCM.

G0557Level 2
~$50/mo

Standard chronic care without the strict 20-minute timer. Ideal for stable T2D patients managed by AI.

G0558Level 3
~$110/mo

Dual-eligible QMB patients with 2+ chronic conditions—hypertension, CKD, or hyperlipidemia alongside T2D—qualify automatically. Zero co-pay, maximum equity and revenue.

See It in Action

Patient View

Riley is ready to follow up on your chronic care plan.

Status: Ready

Provider Dashboard

LIVE

Riley Follows Up By Text, Too

A quick check-in that fits into a patient's day — no phone call required. Try replying below the way a patient would.

Riley works through a few real topics each check-in — how they're feeling, medication adherence, any ER visits — the same way a nurse would.

The whole conversation is automatically summarized into the patient's chart for provider review.

If a patient goes quiet, the check-in is summarized and flagged for the care team — nothing falls through the cracks.

R

Riley

Continua Health

Hey! How's your blood glucose been today?

Ready to Close Your Type 2 Diabetes Care Gap?

Join the waitlist to get early access, or tell us about your practice.