Grove Home Health · A live demo
From Hospital Discharge,
through Recovery, to
profitable episode.
Home health is 11,400 Medicare-certified agencies operating on the OASIS-E and the 485, with paper-thin margins and PDGM payment cliffs. The OASIS takes a field RN two hours per visit. Grove Home Health runs the episode end-to-end on the Grove Clinical Engine — a vertical, AI-native substrate built specifically for regulated post-acute care.
Let me show you a 60-day episode moving through it.
FW
Frank Williams
Just discharged
FromNYC H+H/Jacobi
LOS4 days · acute decomp CHF
Episode60-day MCR-cert
AgencySunrise Home Health
Diagnoses (PDGM clinical group)
CHF · NYHA III · EF 30%
Type 2 DM · A1c 8.6
CKD Stage 3 · eGFR 38
Mild Cog Impair
Venous stasis ulcer · L medial calf
Home + social context
2nd-floor walkup · 4 flights
Widowed (Lillian, 2y)
Daughter Yvonne · 30 min
Union pension
AME Zion
Agency risk profile
Rehospitalization within 30 days would cost ~$8K and trigger a Star Rating downgrade. OASIS-E miscoding on M1830 (bathing) or M1860 (ambulation) shifts the PDGM grouping and changes episode payment by $400+. LUPA threshold of 4 visits looms — under-utilization wipes the episode revenue.
Act 1 · CRM · Tuesday, 9:02 AM
A discharge planner calls. The 24-hour clock starts.
In home health, referrals come from hospital discharge planners — and the agency that responds fastest wins the case. The Medicare Conditions of Participation require an SOC visit within 48 hours of referral acceptance. Watch what happens in Grove Home Health the moment Beth Patel sends the referral.
Beth Patel, RN, the discharge planner at NYC H+H/Jacobi, just confirmed Frank is medically stable for home discharge. She sends the referral via Forcura at 2:14 PM. The 48-hour SOC clock starts. Every hour that passes is risk.
Frank Williams
78 · Mount Vernon NY · Discharge from NYC H+H/Jacobi · received via Forcura, 2:14 PM
New referral
Hospital — NYC H+H/Jacobi
SOC clock: 47h 38m remaining
5 automations fired
Overview
Discharge packet
Eligibility
SOC scheduling
Patient + episode
DOBMar 4, 1948 (age 78)
Phone(914) 555-0317
Address2847 Edenwald Ave, Apt 3B (2nd floor walkup)
DaughterYvonne Williams, RN · 30 min away
Assigned RNMaria Santos, RN (auto-routed)
Service area✓ Mount Vernon · Bronx-adjacent
Medicare A/B✓ Verified · CWF return clean
MA / Sec. payer✓ Original Medicare · no MA plan
Hospital referral context
SourceNYC H+H/Jacobi · Hospital partner
Discharge plannerBeth Patel, RN · ext 4471
Referring MDDr. R. Martinez · Cardiology
Admit dxAcute decomp CHF · I50.23
LOS4 days · discharged today 1:45 PM
Homebound✓ Documented · 4-flight walkup
Skilled need✓ SN + PT + Wound care
Hospital partner scoreTier 1 · 23 referrals MTD
Automations that fired on save: Field RN Maria Santos auto-assigned (territory + caseload + Spanish-language match) · Medicare A/B verified via CWF · MA plan check (none) · Service area validated (Mount Vernon) · Forcura discharge packet ingested (38 docs) · 48-hour SOC clock started · Beth Patel SLA tracker initiated · Hospital partner referral counter +1 · PDGM clinical group pre-classified (MMTA-Cardiac).
Why Grove is different
"In home health, the agency that responds fastest wins the next referral from this hospital. Today, this referral takes a human intake coordinator 30 minutes to triage — and that's if they catch it before the 48-hour clock burns. With Grove Home Health — one save, 9 things happen automatically. The clock isn't a clock anymore. It's a managed SLA with auto-escalation. And Beth Patel's hospital partner score updates live, so when she's deciding which agency to send her next case to, this one wins."
Act 2 · Pre-SOC · 6:38 PM same day · 18 hours before Maria's visit
Maria walks into Frank's apartment knowing
everything that happened in the hospital.
The dirtiest secret of home health: most field RNs walk into the SOC visit with a 4-page faxed discharge summary, no medication reconciliation, and zero context. Today, she'd spend 20 minutes calling the hospital and another 20 piecing the chart together. Grove Home Health pulls the discharge corpus from national HIE networks (Carequality, CommonWell, eHealth Exchange, TEFCA) at the moment the referral is accepted — and drafts a pre-SOC brief while Frank is still in the discharge taxi.
How this works: Grove pulls the discharge summary, the medication reconciliation form, the 5 most recent labs, the H&P, the hospital course note, the cardiology consult, and the discharge instructions from national HIE networks (Carequality / CommonWell / eHealth Exchange / TEFCA-aligned QHIN) via FHIR queries — regardless of which EHR the hospital runs. Three extractors compose against this corpus: Discharge Summary OCR structures the unstructured (autopilot, 96%), Med Reconciliation Hospital→Home reconciles the discharge med list against Frank's pre-admission list and flags changes (suggest, 89%), and Skilled Need Justification drafts the medical-necessity narrative for Medicare (autopilot, 94%). All while Maria's still at her last patient.
Why Grove is different
"Maria's most expensive 30 minutes used to be the morning she walked into a SOC visit cold. She'd call the hospital, get put on hold, get a 4-page fax, and still walk in unprepared. Three extractors run on Frank's discharge corpus while he's in the cab home. By the time Maria opens her phone at 6:38 PM, she has the 3-things-to-know summary, the med-rec discrepancy that will land first thing tomorrow, and a checklist of what to bring. The agency's clinical quality stops being a function of which RN drew the case — and becomes a function of the system underneath every RN."
Act 3 · Clinical · Day 1 · Start of Care visit · 9:00 AM
120 minutes of OASIS-E becomes 35.
Ten extractors compose. Two cameras roll.
The OASIS-E is the most-hated form in American home health. 100+ items, scored, and wired directly to PDGM payment — get one item wrong and you've miscoded the episode. Today it takes a field RN two hours per visit. Maria walks in, opens the ambient session, takes the wound photo, and just talks with Frank and Yvonne. Ten extractors listen — eight against the audio, two against the visual. By the time Maria leaves, the OASIS-E is 88% populated and the wound is staged.
From Act 2: the pre-SOC brief loaded the discharge summary, the med-rec discrepancy is queued, and Yvonne is on her way. Maria opens her tablet at 9:02 AM. The ambient session starts. Ten extractors arm against the shared multi-modal stream — audio + photos.
Ambient session · Start of Care · OASIS-E · Frank Williams
Day 1 · Maria Santos, RN · Frank's kitchen, 2847 Edenwald Ave Apt 3B · Deepgram nova-3-medical · diarized + image-tagged
Live transcript
MS
Frank, tell me how you're feeling today. Anything since you got home from Jacobi?
FW
Tired. Real tired. Made it up the four flights but had to stop twice. Lillian and I lived here forty years. I'm not leaving this apartment unless I have to.
Patient Goals
BH Screen
OASIS-E
MS
Yvonne, you're his daughter — and an RN yourself, that helps a lot. How are you doing with all this?
YW
Honestly? Stretched thin. I keep wanting him to move in with me but he won't. I just want him safe. I can't be here every day. I have my own kids.
Caregiver Strain
Patient Goals
MS
Walk me through your morning. Stairs, bathing, meals, getting dressed.
FW
I do my own bathing. Sit on a shower stool now. I dress myself. The stairs are the hardest part — stair lift on order but not in. I make eggs and toast. Hospital said no salt.
OASIS-E · M1830/M1840/M1860
Home Safety + IADL
MS
Let me look at your leg. Roll up your pant leg for me. [photos captured]
📷
Venous stasis ulcer · L medial calf, gaiter · 6.0 × 4.6 cm · 80% granulation, 20% slough · irregular borders · periwound hyperpigmentation
Wound Assessment · visual
OASIS-E · M1306–M1330
MS
Pain right now? Use the 0-to-10 scale.
FW
Five out of ten when I move. Zero sitting still. The Tramadol helps.
Pain · NRS
Beers · tramadol flag
MS
Three words: Apple, Penny, Table. Now draw a clock face showing eleven‑ten.
FW
[draws] Apple. Penny. ...Table.
OASIS-E · M1700
YW
I picked up the new Lasix this morning. Hospital changed it from 40 once a day to 80 twice a day. I threw out the old bottles so he doesn't get confused.
Beers · Med Rec
OASIS-E · M2001
MS
Mind if I take a couple of pictures around the apartment? Bathroom and the fridge — Grove will pick up what we need from the photos.
📷
Grove detected: toilet grab bar ✓, shower stool ✓, tub grab bar absent ⚠, non-slip mat absent ⚠, adequate overhead lighting, no throw rugs. 2 hazards flagged for OT remediation.
Home Safety + IADL · visual
OASIS-E · M1910 fall risk
📷
Grove detected: fresh produce (spinach, tomatoes, bananas), 2× low-sodium soup cans (Health Valley, 15oz), lean protein (chicken breast, 12 eggs, Greek yogurt — Fage 2%, Oikos 0% plain). Cardiac/renal-friendly stocking pattern. 0 high-Na red flags. Yvonne shops Sundays per Frank.
MNA-SF · visual
Dietary adherence
FW
I just want to walk to the corner deli again. I want to hold my granddaughter at her birthday next month.
Patient Goals
OASIS-E + assessment · auto-populating
OASIS-E · HH anchor
92%
104 of 118 items populated · M1830 bathing: 1 (assist setup) · M1860 ambulation: 3 (supervised, walker) · M1700 cognitive: 2 (mild impairment) · M1306 wound present: yes Stage III · M2001 polypharmacy: 9 meds · M1242 pain interferes: 2 (moderate)
Suggest
Patient Goals Narrative · SW
89%
"Stay in this apartment — Lillian and I lived here forty years. Walk to the corner deli again. Hold my granddaughter at her birthday next month. Don't burden Yvonne — she has her own kids."
Suggest
Wound Assessment · RN · visual
86%
📷 visual
Venous stasis ulcer · L medial calf · 6.0 × 4.6 cm (improved from 6.2 × 4.8 at admit) · 80% granulation, 20% slough · irregular sloping borders · periwound hyperpigmentation (hemosiderin) · healing trajectory positive · 3 photo frames + measurement overlay
Suggest · visual
BH Screen · Behavioral Health
94%
PHQ-9: 6 mild · GAD-7: 3 minimal · bereavement screen positive · 2-yr widowhood (Lillian) · social anchor: AME Zion · post-acute deconditioning fatigue may be confounder
Autopilot
Functional Mobility · PT
91%
Tinetti POMA 19 / 28 · moderate fall risk · TUG 16s · gait initiation hesitant · 4-flight walkup is high-risk · stair lift on order · PT 2× / wk × 4 wks indicated
Suggest
Beers Polypharmacy + Med Rec · Pharmacy
88%
9 medications · hospital → home 3 changes reconciled (Lasix ↑, Spironolactone +, Empagliflozin +) · 1 Beers flag: Tramadol (low-dose, monitor) · old 40 mg Lasix bottles confirmed discarded by Yvonne
Suggest
Extractors armed
HH Anchor · OASIS-E
OASIS-E · 100+ items
Suggest
Social Work · cross-discipline
Patient Goals Narrative
Suggest
Behavioral Health
BH Screen · PHQ-9 + GAD-7
Autopilot
Social Work
Caregiver Strain · Zarit
Suggest
Physical Therapy
Functional Mobility · Tinetti + TUG
Suggest
Occupational Therapy
Home Safety + IADL · HOME FAST
Autopilot
Dietitian
MNA-SF
Suggest
RN
Pain Assessment · NRS + PAINAD
Autopilot
Pharmacy
Beers Polypharmacy + Med Rec
Suggest
RN · 📷 Visual
Wound Assessment · photo + measurement
Suggest
120→35
Minutes per OASIS-E SOC visit
85 minutes back per Start-of-Care visit.
Better presence, better assessment, cleaner episode coding.
Better presence, better assessment, cleaner episode coding.
The split-brain tax of OASIS-E — typing while making eye contact — disappears. Maria reviews the auto-populated assessment for 5 minutes at the end and signs. Across a 14-patient caseload, this is ~20 hours of clinical capacity recovered per RN per week. The deeper win isn't time. It's that Maria captured the wound photo, observed Frank's gait climbing the stairs, and noticed Yvonne's strain — all without breaking eye contact for a form. Coding accuracy improves because the clinician was actually present.
Frank's Patient Goals · in his own words
Captured by the Patient Goals Narrative extractor · suggest stage · 89% approval · Maria reviews and signs · feeds OASIS-E M2102 + Plan of Care
FW
Frank Williams · Patient Goals · in his own voice
Composed from 7 transcript segments by the Patient Goals Narrative extractor · approved by Maria, RN
Suggest · 89%
"I worked the wires for IBEW Local Three for forty-one years. Lillian and I were married fifty-three. I lost her two years ago — heart attack, on a Tuesday. I want to stay in this apartment. Forty years we lived here. I'm not leaving it unless I have to. I made it up the four flights yesterday from the cab — I had to stop twice but I made it. I want to walk to the corner deli again. Two blocks. That's a good goal. I want to hold my granddaughter Imani at her birthday next month — she'll be six. I don't want to burden Yvonne. She's an RN, she has her own kids, her own job. I take my pills. The new water pill is twice a day now. I'd like to keep going to AME Zion on Sundays — that's where my men's ministry is. I want to heal up. I want to stay out of that hospital."
— composed from a 35-minute SOC visit, Day 1, in Frank's kitchen · Maria + Yvonne present · audio + photo playback available at every passage
From Frank's words → six episode goals (Plan of Care)
Auto-derived from the Patient Goals narrative · all six populated as AmbientField values · feed the 485 Plan of Care · Maria + Dr. Patel confirm before signature
Goal 1 · Top priority
Heal the venous stasis ulcer
Wound care 3×/wk × 4 wks → 2×/wk × 4 wks. Goal: Stage III closed by Day 60. Photo-tracked at every visit. Nutrition + protein supplementation supports.
Goal 2 · Avoidance
Stay out of the hospital
CHF home monitoring (RPM scale + BP cuff). Hospitalization risk model armed. Daily weights. Fluid restriction 2L/day. Yvonne briefed on red flags.
Goal 3 · Function
Walk to the corner deli
PT 2×/wk × 6 wks. Goal: 4-flight walkup with single rest by Day 30, two-block walk by Day 60. Stair lift install pending — track to completion.
Goal 4 · Family
Imani's birthday · Day 35
Discrete date-target goal — appears in Maria's app + Family Portal. Yvonne updated. Visit cadence pre-flexed for that week. Granddaughter visit becomes a clinical milestone.
Goal 5 · Identity
AME Zion · men's ministry
Sunday return is a measurable functional milestone (sustained sit, social tolerance). Visit cadence respects Sunday morning. Church transport coordinated with Access-A-Ride.
Goal 6 · Caregiver
Don't burden Yvonne
Aide hours added Wks 2–4 (3×/wk × 3h). Family Portal keeps Yvonne informed without pulling her in. Caregiver Strain extractor re-armed for recert at Day 56.
Why Grove is different
"Look at the rail. Ten extractors composing on one shared multi-modal stream — eight against the audio, two against the photos. The OASIS-E extractor is the anchor — 100+ items, every one of them tied to PDGM payment. The Wound Assessment extractor is the visual proof: it measured, staged, and compared Frank's wound to the hospital baseline in 3 seconds. The Patient Goals Narrative captured Frank's actual life — Imani's birthday, the corner deli, the men's ministry — which becomes the Plan of Care. The competitor's 'OASIS automation tool' is a single autocomplete on a single form. Grove is a multi-modal ambient session that produces a complete, audit-ready, payment-grade clinical document — and gives Maria back 85 minutes of clinical time per visit. Across her 14-patient caseload, that's 20 hours a week back to actual care."
Act 4 · Clinical · Day 1, 11:42 AM · 5 minutes after Maria signs the OASIS-E
From signed OASIS-E to MD-signed 485.
Eight minutes, four extractors.
Medicare requires a physician-signed Plan of Care (CMS 485) before any skilled visit can be billed. Today, this is a 2-hour drafting process, a faxed PDF chase, and an average 6-day round-trip with the physician. Grove drafts the 485 directly from the OASIS-E, computes the PDGM grouping, recommends visit frequency, and pushes to DocuSign — all in eight minutes. The 5-day clock becomes a same-day clock.
From Act 3: OASIS-E is signed. Frank's Patient Goals are captured. Wound is staged. Four extractors arm against the OASIS-E + discharge corpus to draft the 485 — and route it for signature.
How this works: The 485 POC Drafter composes the Plan of Care document from the structured OASIS-E + Frank's narrative. The Visit Frequency Recommender computes a discipline-by-discipline visit cadence based on his clinical group and functional impairment level. The Skilled Need Justification extractor drafts the medical-necessity narrative that proves Medicare coverage. The PDGM Case-Mix Optimizer computes the episode HIPPS code and flags any items that would shift case mix if updated. Dr. Anita Patel signs in DocuSign in 90 seconds.
PDGM Episode Grouping · Auto-computed
HIPPS code: 2DA21
5-character payment code · drives episode reimbursement
2
+$1,142
Clinical group
MMTA-Cardiac/Circulatory · CHF principal Dx
D
×1.234
Admission source · Timing
Institutional · Early (1st 30-day period)
A
+$418
Functional impairment
Medium · OASIS M1830/M1860/M1840 score
21
+$687
Comorbidity adjustment
High · CHF + DM + CKD + Stage III wound
Episode payment (30-day period)
$4,847
Base + adjustments. LUPA threshold: 4 visits — fall below and the episode collapses to per-visit payment (~$682). Grove visit-cadence recommender holds the floor at 6 visits in period 1.
Why Grove is different
"Two of the worst bottlenecks in home health: the 485 takes a week to get back from the doctor, and the visit cadence is built in someone's head from a spreadsheet template. Grove fixes both. The 485 drafts itself from the OASIS-E in eight minutes. The Visit Frequency Recommender computes a discipline-by-discipline cadence that's PDGM-aware AND LUPA-safe. Dr. Patel signs in DocuSign while she's between Jacobi rounds. The economic point is unsubtle: every day this 485 sits unsigned, the agency can't bill skilled visits. Grove turns a 6-day median round-trip into same-day. That alone changes Sunrise's working-capital position."
Act 5 · Clinical · Day 8 · Maria's third visit · 10:14 AM
The wound is healing.
Grove saw it before Maria did.
Eight days into the episode, Maria's on her third visit to Frank. Today's a routine wound care + CHF check. The ambient session opens. Five extractors compose — three on audio, two on visuals. The Wound Assessment extractor pulls the photo, measures it, and compares it to the Day 1 baseline. The Hospitalization Risk Model — quietly running in the background — has already updated Frank's risk score. Grove saw the trajectory before Maria opened the dressing.
From Acts 3 + 4: Frank's OASIS-E + 485 + Plan of Care are live. Three SN visits per week through Wk 4. Today, Maria has 5 visits on her route. Frank's is the third. Grove drafted her pre-visit brief while she was driving, including RPM signals from Frank's home BP cuff (stable) and scale (stable, no fluid gain).
RPM signals · 7-day trend
Weight
197 lb ↓1 from baseline
BP
122 / 76 7-day avg
Lasix adherence
100% 14 of 14 doses
Hospitalization Risk Score
0.21 ↓ from 0.34
Autopilot · 93% · 30-day rehospitalization probability
Wound Assessment · L medial calf VLU · Day 1 → Day 8 comparison
Visual extractor · photo + measurement + comparison · auto-staged · 86% approval
Day 1 · SOC visit: 6.0 × 4.6 cm · 80% granulation · 20% slough · irregular borders · periwound hyperpigmentation · no purulence
Day 8 · today: 4.9 × 3.8 cm · 92% granulation · 8% slough · contracting from edges · hyperpigmentation receding · no purulence
Healing trajectory · auto-computed
Surface area−32% (27.6 → 18.6 cm²)
Granulation+12pp (80% → 92%)
Slough−12pp (20% → 8%)
Bates-Jensen score26 → 21 (improvement)
Pain (NRS movement)5 → 3
Trajectory: AHEAD of healing curve. At this rate, projected closure by Day 48 — 12 days ahead of Plan-of-Care goal (Day 60). Continue current dressing protocol. Suggested: step down SN frequency to 2×/wk a week early (Wk 4 → Wk 3).
Visit note · auto-drafted · ready for Maria's signature
Composed by SOAP Draft + Vitals + Wound Assessment + Med Rec extractors · 22-min visit · Maria reviewed in 90 sec
SUBJECTIVE
Pt reports feeling "stronger than last week." NRS 3/10 at L calf with weight-bearing, 0/10 at rest with leg elevated. Daughter Yvonne reports pt walked down 2 flights of stairs Sunday for the first time. Sleeping flat (1 pillow). No SOB at rest, no orthopnea, no PND. Appetite improved.
OBJECTIVE
Vitals: BP 124/74, HR 70, RR 16, SpO2 96% RA, T 98.2, Wt 197 lb (↓1 from baseline). Lungs clear. JVD not elevated. Trace BLE edema. Wound L medial calf VLU: 4.9×3.8 cm, 92% granulation, contracting from edges, no signs of infection. Periwound hyperpigmentation receding. Compression wrap applied. Ambulating to bathroom independently with shower stool.
ASSESSMENT
(1) CHF — clinically improving on optimized regimen. (2) Chronic venous stasis ulcer L calf — healing ahead of expected trajectory on compression + dressing protocol. (3) T2DM — A1c last 8.6, fingersticks 130–180 fasting. (4) Polypharmacy — adherence 100%. (5) Functional — mobility improving, 2-flight walkup achieved.
PLAN
Continue current dressing protocol — alginate + foam secondary, change q3d. Suggest stepping down SN to 2×/wk starting Wk 4 (one week early) given trajectory. Continue PT 2×/wk (started Wk 2). Reinforce sodium <2g, fluid <2L, daily weights. Yvonne briefed on weight-gain red flags. Next visit: Day 11.
SOAP Draft · Suggest 91%
Vitals capture · Autopilot 98%
Wound Assessment (visual) · Suggest 86%
Med Rec · Suggest 88%
Hospitalization Risk Model · Autopilot 93%
Day 13 · telehealth follow-up + Family Portal
Day 13 post-discharge review — agency-hosted, multi-stakeholder. Sarah (admin) coordinates while Maria's on her route. Frank takes his RPM vitals live on camera. Denise (HHA) and Yvonne (RN, daughter) join from the field. The same ambient session runs against the call. Vitals stream from Frank's RPM. Routed to Maria when she's back at her desk.
Why Grove is different
"Three things that didn't exist before Grove. One: the wound trajectory is computed automatically. Maria didn't pull out a ruler — she took a photo. The extractor measured, compared, and projected closure by Day 48. Two: the Hospitalization Risk Model has been quietly running on every signal — RPM weight, BP, adherence data, visit notes — and Frank's score dropped from 0.34 to 0.21 over the week. Three: the Day 13 telehealth review. Frank takes his BP and SpO2 on camera; Grove ingests them live. Denise the HHA flags the edema visually. Sarah hosts and routes everything to Maria. Four people on a video call, four-speaker diarization, seven extractors live, a SOAP note ready for Maria's review by lunch. And the Family Portal closes the loop with Yvonne — she sees the trajectory, the schedule, and Imani's-birthday goal-tracker, without a single phone call to the agency."
Act 6 · Clinical · Day 10 · Maria's morning prep · 7:48 AM
Maria needs to think. She opens Grove.
Grove isn't only a workflow tool — it's a clinical thinking partner. Maria's reviewing her route this morning and Frank is doing better than expected. She's wondering: should I do an in-person visit Day 11 as planned, or pivot to a telehealth check? Her LUPA threshold is in play either way. She wants to think it through with someone who knows everything about Frank's episode. So she opens Grove.
From all prior acts: Grove has read Frank's OASIS-E, his Patient Goals, every visit note, every wound photo, every RPM data point, the 485, the PDGM grouping, and 42 CFR 484 visit-cadence rules. When Maria asks a question, Grove answers like the colleague who's read every chart.
How this works: Grove operates in three modes — Clinical (patient care reasoning), Research (evidence and best practices, with citations), Coaching (professional growth, documentation habits). Clinician-first, always. Speaks when spoken to. Cites 42 CFR 484 specifically. Never directs — only drafts, suggests, prepares. And every interaction is logged in the Judgment Tracker so the agency can see how AI is being used — adopted, adapted, or set aside in favor of clinician judgment.
Why this matters
Generic AI can't do this. ChatGPT doesn't know the LUPA threshold for Frank's specific episode. Doesn't know 42 CFR 484.55(c). Doesn't know his Plan of Care includes a telehealth substitution clause. Doesn't know his wound trajectory or the Day 50 flag-back logic.
Grove does — because Grove lives where the data lives. Vertical AI built on top of a vertical operating system. The competitive moat isn't the model — it's the data plumbing under it.
Grove does — because Grove lives where the data lives. Vertical AI built on top of a vertical operating system. The competitive moat isn't the model — it's the data plumbing under it.
Three modes
Clinical · patient reasoning, care planning, clinical judgment support — currently active
Research · evidence, studies, best practices — surfaces with citations
Coaching · documentation habits, professional growth — confidential, not shared with management
Brand principle
"Speak when spoken to. Suggestions are optional. Clinicians feel Grove is their tool — not management's eye."
High independent-judgment rates in the Judgment Tracker are a sign of clinical strength, not non-compliance.
High independent-judgment rates in the Judgment Tracker are a sign of clinical strength, not non-compliance.
Why Grove is different
"This is what trust-with-AI looks like in healthcare. Grove isn't autocompleting a SOAP note — it's the colleague who's read every chart, knows every reg, and remembers Frank's husband's name. Notice what Grove didn't do: it didn't tell Dr. Anita Patel what to do. It surfaced context, offered three considerations, and put the decision back in her hands. That's why clinicians actually use it."
Act 7 · Quality + OASIS Audit · Day 14 · agency dashboard view
Every OASIS item, every visit, every Star Rating component
auto-audited.
In home health, OASIS-E accuracy isn't paperwork — it's payment. The agency that miscodes M1830 (bathing) loses $340 per episode. The agency that misses an OASIS audit gets a CMS condition-level deficiency. The agency that drops a Star Rating loses hospital partner referrals. Grove makes audit-readiness a continuous state, not a panic project.
From all prior acts: Frank's OASIS-E, 485 signatures, visit notes, wound photos, and clinician credentials all flow into the audit trail automatically. Nothing is "documented later." Documentation IS the workflow.
CMS audit readiness
94%
↑ +8% this quarter
CMS Star Rating
4.5 / 5
+0.5 from Q3 2025
OASIS-E item accuracy
98.2%
vs. industry 91.4%
Open CAPAs
3
1 at risk
42 CFR Part 484 · Frank's compliance footprint
Auto-tracked from referral acceptance forward
| Citation | Requirement | Frank's status |
|---|---|---|
| 484.55 | SOC visit within 48 hours of referral acceptance | ✓ 19h post-accept |
| 484.60 | Plan of Care MD-signed before billable visit | ✓ Day 1, 1:42 PM |
| 484.45 | OASIS-E timely submission (30 days) | ✓ Submitted Day 4 |
| 484.65 | QAPI signal logged for clinical events | ✓ Auto-logged |
| 484.110 | Clinical record retention (5 yr) | ✓ Vault active |
| 484.50 | Patient rights notice + acknowledgment | ✓ E-sign Day 1 |
CMS Star Rating · component health
Quarterly · drives hospital partner referral preference
Improvement in ambulation81% · ★★★★½
Improvement in management of oral medications76% · ★★★★½
Improvement in dyspnea79% · ★★★★½
Acute care hospitalization (lower=better)11.4% · ★★★★½
Timely initiation of care98% · ★★★★★
Patient experience · HHCAHPS88% · ★★★★
Pattern intelligence
HHCAHPS dropped from ★★★★½ to ★★★★ last quarter. Grove correlated open-ended responses: "didn't know who was coming" appeared 14× — a scheduling-communication signal. Auto-routing micro-training to scheduling team + Family Portal reminder template before manager has to escalate.
OASIS-E pattern intelligence · 17 charts flagged
Grove's audit agent runs nightly · cross-references coding patterns against PDGM payment outcomes · catches what the human auditor would catch in Q3 — in week 1
CAPA-OASIS-Q1-12 · M1830 vs M1860 misalignment pattern
Detected May 5, 2026 · 17 charts affected · estimated revenue impact −$5,780 if uncorrected before submission
PatternM1830 (bathing) coded "independent" while M1860 (ambulation) coded "supervised w/ device"
IssueInconsistent — typically these correlate
PDGM impactFunctional impairment shifts to lower category
$/episode−$340
Affected RNs4 (3 < 1 yr tenure)
Auto-actionCharts queued for QA review pre-submission
TrainingMicro-module assigned to 4 RNs
StatusCAPA drafted · awaiting QA Director sign-off
May 5, 02:14 AM
Pattern detected · OASIS audit agent
Cross-reference against 412 episodes flagged 17 charts with M1830 + M1860 inconsistency.
May 5, 02:18 AM
CAPA auto-drafted
Pattern → micro-training module assigned to 4 RNs. Charts held for QA review before submission.
May 5, 8:03 AM
QA Director review
CAPA drafted · awaiting Director sign-off · revenue at risk if not corrected pre-submission.
Why Grove is different
"CMS Conditions of Participation surveys don't fail because home-health agencies don't care — they fail because they document in 17 places. Grove is the single source of truth. The bigger story is that Grove's OASIS audit agent caught a $5,780 coding pattern issue at 2 AM that a human auditor would have found in Q3. Multiply that by 50 patterns a year, by 400 episodes per agency, by however many agencies are in the rollup. This is the engine that turns audit from cost center into revenue protection. And the Star Rating uplift — from 4.0 to 4.5 — is what makes Beth Patel send the next 100 referrals to Sunrise instead of the agency down the street."
Act 8 · Revenue Cycle · Day 60 episode close · path to profitability
Frank's episode locks at $4,847.
The agency's margin grows.
Home health agencies aren't health plans — but they live and die on coding accuracy, claim cleanliness, denial prevention, and Star Rating-driven referrals. Most agencies leak 6–11% of episode revenue to denials, downgrades, and miscoded OASIS items. Grove closes the loop from clinical encounter to claim submission to denial-prevented to referral-attracted. Walk through Frank's episode revenue + the agency-level engine behind it.
From all prior acts: Frank's OASIS-E was coded with 92% extractor accuracy + RN review. PDGM grouped MMTA-Cardiac (HIPPS 2DA21). 485 signed Day 1. Visits stayed above LUPA. OASIS audit pattern caught a $5,780 misalignment before submission. Today, Day 60, the episode closes — and the claim flows clean.
Frank · 30-day period 1
$4,847
Locked · clean claim
Frank · period 2 (recert)
$4,612
Projected · pending
Clean claim rate
96.4%
vs. industry 87%
Days sales outstanding
38d
↓ from 52d
Annualized margin lift
+$1.8M
Sunrise FY 2026
The path to revenue · 5 stages, 1 engine
From clinical encounter → submitted claim → paid claim → grown agency
1
OASIS-E accuracy
10 extractors compose at SOC + recert. 98.2% item accuracy vs. industry 91.4%.
+$340/episode avg
2
PDGM optimization
Case-mix optimizer flags items where re-evaluation could shift HIPPS. LUPA-safe visit cadence.
−72% LUPA loss
3
Clean claim submission
Auto-coded RAP + final claim. Pre-submission edits scrub against MAC rules + LCD policies.
96.4% clean rate
4
Denial prevention
Pattern intel flags Skilled-Need + Homebound documentation gaps before claim submits.
3.6% denial rate
5
Star Rating → growth
4.5★ Star Rating drives hospital partner referrals. Beth Patel's tier-1 score keeps Sunrise top of list.
+27% referral volume
Frank's episode claim · Day 60 close
From OASIS-E to paid claim · 38 days end-to-end
| Component | Detail | $ |
|---|---|---|
| Period 1 base | MMTA-Cardiac · HIPPS 2DA21 · institutional · early | $4,847 |
| Functional impairment | Medium · OASIS validated | incl. |
| Comorbidity | High · CHF + DM + CKD + wound | incl. |
| NRS supply add-on | Wound care alginate + foam (Day 1–35) | +$184 |
| Q-codes (LUPA risk) | ✓ Above threshold (12 visits) | $0 lost |
| Denial reserve | Pre-submission scrub passed | $0 |
| Period 1 net | Submitted Day 32 · paid Day 38 | $5,031 |
| Period 2 base (recert) | Late · community admit · projected | $4,612 |
| Episode total (projected) | If recert continues | $9,643 |
Without Grove: at industry-average OASIS accuracy, Frank's episode would have grouped 1 case-mix bucket lower (HIPPS 2BA21), paid ~$4,420 for period 1. The $611 difference is what 92% extractor accuracy + pre-submission scrub looks like for one patient.
Sunrise · agency revenue cycle dashboard
Live · 412 active episodes · YTD performance
Episodes auto-grouped at HIPPS submission
408 / 412 99%
Pre-submission scrub catches
47 issues $23K saved
Denial rate (post-Grove vs. pre)
3.6% ↓ from 8.2%
Recovered denied claims (Grove appeal-draft)
73% $84K YTD
LUPA loss (uncaught visit shortfalls)
2 episodes ↓ 72%
Path to profitability · annualized for Sunrise (412 active episodes)
+$680K
Coding accuracy uplift (avg +$340/ep × 2 periods × 412/yr / 2 episode-equiv)
Coding accuracy uplift (avg +$340/ep × 2 periods × 412/yr / 2 episode-equiv)
+$420K
Denial prevention (industry 8.2% → 3.6%)
Denial prevention (industry 8.2% → 3.6%)
+$700K
Star-driven referral growth (4.0 → 4.5 ★ → +27% volume)
Star-driven referral growth (4.0 → 4.5 ★ → +27% volume)
≈ $1.8M annualized margin lift · ~6.4% of total agency revenue
Why Grove is different
"This is the part nobody else does. Most clinical-AI tools stop at documentation. Grove closes the loop to revenue — without being a health plan. Five stages, one engine: OASIS accuracy, PDGM optimization, clean-claim submission, denial prevention, and Star-driven growth. $1.8M of annualized margin lift for a single 412-episode agency. Multiply by the 1,400 agencies in the PE rollups alone. This is the compounding moat: clinical encounters become structured data, structured data becomes clean payments, clean payments become higher Star Ratings, and higher Stars become referral volume. Each turn of the wheel makes the next turn faster."
Close · the full picture · Day 60 · episode complete
Frank healed.
The agency grew. One engine made it all happen.
We followed Frank through 60 days, ten extractors, two visual modalities, one MD-signed 485, one PDGM-optimized claim, and one clean episode close. Today, home-health agencies run this on point-of-care software from 1998 plus Excel plus paper plus a billing vendor in Tampa. Grove Home Health replaces the stack — and it's the same engine that runs Grove PACE.
Frank Williams · what changed in 60 days
Concrete outcomes from one operating system
Rehospitalizations
0
vs. expected 0.34 (CHF post-acute)
Venous stasis ulcer
Closed
Day 51 · 9 days ahead of POC
Episode revenue (period 1)
$5,031
Clean claim · paid Day 38
Imani's birthday
Day 35 ✓
Frank held his granddaughter
Why Grove is different · the close
"What you just watched isn't a second product. It's the same product applied to a second care model. Wrapper #1 took 14 months to build. Wrapper #2 took 8 weeks. Wrapper #3 will take 6. Each new wrapper adds a regulatory schema, a payment mechanic, and a small set of domain-specific extractors — and inherits the entire engine for free. The pitch I'm making is for PACE. The bet I'm asking you to make is on the engine. When PACE alone hits $25B by 2030, you've already won. When LTSS, SNF, and ACO REACH ship on the same engine, you've defined a category."