← back to OneMoreThing index

Polychronic care management

Doctors spend most of their time working within EHRs, but often lack visibility into what’s happening across their care team. Luma serves as a smart sidekick that lives right inside the EHR, giving doctors an instant window into care activities, updates, and patient progress without ever leaving their workspace. It also provides high risk alerts & other care recommendation that improves documentation accuracy and reduce denials. By seamlessly connecting to Nova's capabilities, Luma keeps doctors informed, coordinated, and in control—without breaking their clinical flow.

Client
Supercare
Roles & Responsibilities
Users
Devices

The Problem

One word. Data fragmentation.

Context switching
Post visit documentation
Claims denial
Gaps in care
Gaps in documentation
Out of sync care

Doctors spend ~50–60% of their day inside EHRs yet lack visibility into what their care teams are doing. Coordination breakdowns lead to duplicated work, care gaps, and billing denials.

Contextual inquiry & shadowing sessions

We conducted 3 CI and shadowing sessions with physicians as well as care teams and uncovered important details.

Theme Observed Behavior Quote / Signal Opportunity
Documentation Overload Physicians manually toggle between encounter notes, lab results, and patient chats; average 50–70 clicks per visit. “By the time I finish charting, I forget what my nurse already updated.” Automate note drafts and inline summaries to reduce after-hours charting.
Care Gaps Visibility Doctors depend on care managers or nurses to remind them of overdue screenings or pending outreach. “I usually find out a screening was missed during the next visit.” Surface actionable care gaps and overdue screenings during patient encounters.
Coding & Billing Stress Physicians often leave billing codes incomplete, relying on coders to fix errors post-visit. “Queries come back days later — I barely remember the case.” Auto-suggest HCC codes and flag documentation gaps before case closure.
Claims & Denial Rework Documentation gaps lead to claim denials and back-and-forth with billing staff. “It’s a game of ping-pong with the billing team every week.” Automate validation and CDI alerts before submission.
Cost Transparency Confusion Physicians prescribe without real-time view of patient affordability or generic options. “Patients call later saying the meds were too expensive — I had no idea.” Show guideline-adherent, affordable alternatives during prescribing.
High-Risk Patient Blindness SDOH or behavioral data buried deep in EHR; not visible in real time. “We know she’s at risk — but it’s hidden three tabs away.” Pin top SDOH risk factors (housing, transport, safety) contextually in the workflow.
Education Timing Gap Patient education happens reactively, not contextually during visits. “I wish the system just reminded me to share the right info at the right time.” Trigger smart, context-aware education messages.
After-Hours Burnout Post-visit charting and follow-ups spill into personal hours. “My real work starts after clinic ends.” Streamline routine admin tasks, prioritize high-impact actions, and promote physician wellbeing.

Decoding core jobs to handle

Job To Be Done Contextual Inquiry Insight (What We Saw & Heard) Underlying Emotion / Pain Signal Design Insight for Loma Sidekick
Minimize documentation workload During observations, doctors toggled between multiple screens — notes, labs, messages. Many stayed back after clinic hours to complete charting. “I finish notes at 9 PM. That’s when I finally feel caught up — and also completely drained.” (Frustration + Resignation) Automate/draft notes inline; summarize care threads contextually to reduce after-hours load.
Address care gaps and overdue actions Doctors often learned about missed screenings or overdue labs only when patients revisited. Most relied on manual reminders from care teams. “I wish the system just told me what’s overdue before the visit — not after.” (Anxiety about missing care) Surface actionable care gaps and screenings within the doctor’s workspace in real time.
Improve coding and billing accuracy Many physicians admitted skipping detailed coding mid-visit, deferring to billing staff, causing revenue delays. “Coding slows me down — I’ll just finish the note and let billing fix it.” (Avoidance + Dependency) Provide smart auto-suggestions for HCC and risk codes before closing the case.
Reduce denials and streamline queries Revenue managers shared that most denials came from documentation inconsistencies between physicians and care teams. “We lose days reworking denials for things that should’ve been right the first time.” (Inefficiency fatigue) Validate documentation in real-time; show coding and compliance prompts contextually.
Make cost-effective treatment decisions Doctors lacked instant visibility into patient affordability or formulary coverage during prescribing. “Patients text later saying they couldn’t buy what I prescribed — that’s heartbreaking.” (Empathy + Helplessness) Show guideline-based, affordable alternatives during the prescribing moment.
Act on high-risk and social determinants SDOH data (housing, safety, transport) existed in EHR but buried in other modules, unseen during encounters. “We know she’s high-risk, but that info lives three clicks away — useless in real time.” (Concern + Powerlessness) Surface SDOH risk flags contextually and nudge doctors for social issue follow-ups.
Educate patients with right info at right time Patient education typically occurred post-visit or reactively after a message, missing high-engagement moments. “I forget to send materials when I’m focused on finishing the encounter.” (Overload + Regret) Trigger contextual patient education prompts during the visit.
Feel supported, reduce burnout Many physicians described emotional fatigue — feeling like they’re managing tasks, not patients. “Some days, I feel like a clerk, not a clinician.” (Disillusionment + Burnout) Reduce administrative overhead through prioritization and automated summaries; restore focus on care.

Distilling learnings into tangible insights

Doctors aren’t asking for another dashboard — they want quiet clarity inside the one they already live in.

Design explorations

We created 5-6 versions of this concept. From invocation pill to the smart summaries, we iterated and took feedback.

Ela’s adoption showed 30% reduction in overall bounce rate and increase in CSAT. Members mostly arrived confused for meet & greet. Now 90% patients arrive informed and books appointment instead of meet & greet

Increase in first response time

Lower bounce rates

Increase in conversion

Increased patient confidence

Reduced staff workload

Increase in PSAT