How We Measure Care Continuity

Every metric on this page has a precise definition, a documented calculation method, and a traceable data source. Nestmate Health publishes its outcomes methodology to make claims independently verifiable — for founders, payers, health systems, and regulators. The platform is built to AHRQ's definition of care coordination and CMS's referral-loop closure standard.

Key Performance Metrics

85% — Fewer Lost Referrals
Percentage reduction in referrals that failed to reach closed status (specialist notes returned and acknowledged by PCP) within 30 days, compared to baseline period before platform adoption. Calculated across participating practices over a rolling 90-day window.
1–2 weeks — Average Time to Scheduled
Median calendar days from referral submission to confirmed appointment date, across all specialties and urgency tiers on the platform. Excludes referrals cancelled before scheduling.
4.9★ — Provider Rating
Mean star rating (1–5 scale) submitted by patients and referring providers on completed referral workflows. Surveys sent 48–72 hours post-visit; response rate tracked separately.
24 hours — Referral Response SLA
Target maximum time for a receiving specialist practice to accept or respond to a submitted referral. Auto-escalation triggers at 24 hours for non-responses.
≤3 days — Consult Note Return Target
Target maximum days from visit completion to specialist notes being returned to the referring PCP — the core measure of closed-loop referral completion per CMS standards.
≤20% — Network Leakage Target
Percentage of referrals that route outside the enrolled specialist network. Lower leakage equals better network integrity and care continuity.

The Closed-Loop Referral State Machine

Every referral on the platform moves through a strict six-stage state machine enforced at the API level. Each state transition is timestamped and role-gated.

  1. Referral Created — PCP submits referral with patient info, diagnosis, and urgency. Timestamp recorded.
  2. Accepted by Specialist — Receiving practice accepts within SLA. 24-hour auto-escalation if no response.
  3. Appointment Scheduled — Specialist confirms appointment date. Patient notified.
  4. Visit Completed — Specialist marks visit done. Consultation notes entry triggered.
  5. Notes Returned to PCP — Specialist sends consult note to PCP with AI-extracted summary.
  6. PCP Acknowledges & Closes — Referring PCP reviews findings and formally closes the referral. Loop is confirmed closed.

AHRQ & CMS Standards Alignment

Care coordination
AHRQ defines care coordination as deliberately organizing patient care activities and sharing information among all participants. Nestmate implements this through a shared referral timeline visible to PCP, specialist, coordinator, and patient, with real-time status updates and role-based work queues.
Closed referral loop
CMS requires the referring provider to receive a report back from the specialist confirming the consultation outcome. The platform enforces an explicit 4-stage closure workflow: Visit Completed → Notes Returned → PCP Acknowledged → Loop Closed. Each stage is timestamped and auditable.
Transitions of care
The Transitional Care Events module tracks hospital discharges with auto-scheduled 7-day and 30-day follow-up tasks. Coordinator alerts fire when follow-ups are approaching or overdue.
Exception management
The MATE AI scheduler runs every 6 hours and auto-escalates: stalled referrals over 5 days in “new” state, stalled referrals over 7 days in “accepted” state, prior auths pending over 72 hours, and overdue transitional care follow-ups.

Transparency and Limitations

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