Specialty care infrastructure

Infrastructure for specialty care, anywhere.

Pointwell partners with health system specialists to codify their visit types and diagnostic protocols — enabling PCPs and APPs to perform guided, AI-supported workups before the specialist visit. Specialists stay central, focus on what they do best, and see more patients.

Specialty access in America, today
US adults facing specialty access barriers28%
CHC medical directors reporting difficulty obtaining specialist visits for Medicaid patients~60%
ED doctors citing specialty delays driving ER visits75%
Rural counties with zero adult rheumatologists93%
With a Pointwell care pathwayDay 1 access
What we are

We're not the doctors.
We turn specialist knowledge into infrastructure.

Pointwell is the platform that codifies how great specialists work — translating their clinical expertise into repeatable, AI-guided pathways that any PCP or APP can execute. The specialist remains the expert. Pointwell makes that expertise scalable.

The problem

Specialty care is structurally out of reach for most Americans.

Only the largest academic medical centers can economically support dozens of specialty service lines. This leaves rural, underserved, and Medicaid patients without timely access — and leaves health systems bleeding revenue through avoidable referral leakage.

28%

Of the US population experienced a barrier accessing specialty care for themselves or their family in 2024.

60%

Of specialty offices face challenges accepting Medicaid patients — vs. 96%+ for private insurance.

31 days

Average wait time for a physician appointment across six specialties in 15 major US metro areas — up 19% since 2022 and 48% since 2004.

75%

Of ED doctors note that ED visits have risen because patients cannot obtain specialty care in a timely manner elsewhere.

93%

Of rural counties in the US have zero adult rheumatologists — 95% of specialists cluster in urban areas.

86K

Physician shortfall projected by AAMC by 2036 — while the NP workforce is expected to grow 46% by 2031.

📍

Rural patients face severe geographic bottlenecks, with local hospital closures forcing many residents to travel 20–40 miles further for routine or specialized services. The problem compounds every year specialist supply doesn't keep up with demand.

Why this matters to health systems financially

Referral leakage quietly erodes health system revenue.

This widespread issue not only fragments patient care — it also strains healthcare finances, often without health systems fully understanding the extent of their losses.

$1.6–$2.7M
Specialist-Driven Revenue

Specialists can drive up to $2.7M annually for health systems, compared to primary care which drives ~$1.4M. Losing that referral pathway means losing far more than the visit itself.

$971K
Lost Revenue Per Physician

Annual patient leakage costs per physician, directly impacting health system profitability — often invisible on a line-item basis but compounding across every specialty gap.

10–30%
Hospital Revenue Lost

The average percentage of revenue hospital systems lose on out-of-network referrals. Every patient sent out becomes downstream labs, infusions, and prescriptions that leave with them.

95%
Medicare Expenditures

Of Medicare expenditures are attributed to care beyond primary care. Specialty care isn't a feature of health systems — it's the financial core. Leakage in this layer is existential.

Voice of the customer

Three gaps. One platform.

Many health systems experience at least one of the following three gaps across different specialties — and Pointwell is designed to fit the full spectrum, from zero coverage to an overloaded practice.

Access gap
"We can't afford to recruit or retain a rheumatology practice — and there's no substantive practice nearby. Patients are referred to distant providers with long wait times."
Retention gap
"We have a strong local dermatology partner, but wish we could retain more of this caseload — referring out only the most complex cases."
Capacity gap
"We have an endocrinology practice, but backlog and wait times are a problem. We're vulnerable to referral leakage and need help managing demand without compromising our specialists."
How Pointwell works

Specialists define the pathway. Pointwell runs it.

Pointwell doesn't replace specialists — it extends them. By codifying specialist visit types and diagnostic protocols, Pointwell enables PCPs and APPs to complete the workup before the specialist joins, so every specialist minute goes toward expert diagnosis and treatment.

Platform preview

Pointwell's AI reviews PCP notes, recommends the appropriate specialty visit type, and surfaces the specialist-approved diagnostic workup — all before the specialist joins.

pointwell / specialty-evaluation
Incoming Referral
PatientAdult, 54F
Referred byDr. Patel, FNP (Internal Medicine)
SpecialtyRheumatology
UrgencyRoutine — within 30 days
PCP Visit Notes
"Patient presents with bilateral hand joint swelling and morning stiffness lasting >1 hour for the past 6 weeks. ESR elevated at 48. No prior rheumatologic workup. Family hx of RA. Requesting specialist evaluation."
✦ AI Recommendation
Inflammatory Arthritis — Initial Workup
Match confidence: 94% · Specialist-approved pathway
Diagnostic Workup Steps
1
Complete CBC with differential Baseline labs — order before visit
2
Rheumatoid Factor (RF) + Anti-CCP antibodies Diagnostic markers for RA confirmation
3
ANA panel + ESR + CRP Rule out other inflammatory conditions
4
X-rays: bilateral hands and feet Assess for joint erosion
5
Document joint count and DAS28 score Specialist uses to guide treatment plan
01

Partnership & codification

Specialists define visit taxonomy and workup protocols with Pointwell, embedded into existing health-system workflows.

02

AI-powered recommendation

AI analyzes PCP notes and recommends the optimal specialty visit type for every incoming referral.

03

Specialist sourcing

Pointwell automatically identifies and connects the right credentialed specialist for review and approval.

04

Guided diagnostic workup

The PCP completes the specialist's checklist; Pointwell generates an AI-powered summary before the specialist joins.

05

Collaborative specialist visit

Specialist joins virtually — live or async — while the PCP stays with the patient. Fully prepared, the specialist focuses on diagnosis.

06

Care plan & follow-up

Specialist notes recorded; PCP owns prescriptions and ongoing care — entirely inside the health system.

⏱️

Decrease wait times

Patients access specialty care sooner through guided PCP workups that prepare for the specialist visit.

🎯

Increase specialist capacity

Specialists see more patients by focusing exclusively on high-value diagnosis and treatment — not intake.

🏥

Retain patients in-system

Keeps the specialty visit, downstream labs, infusions, and prescriptions inside the health system.

🩺

Optimize APPs without compromising specialist value

Increasing NP and PA productivity to meet the national median represents $1.1–$3.6M in additional annual collections per health system.

Strategic fit

Built for health systems and the providers inside them.

Pointwell creates aligned incentives across the care team — health systems retain patients and revenue, while APPs and PCP clinics gain scope, satisfaction, and financial upside.

For Health Systems

Pointwell fits wherever you are on the specialty access spectrum.

01 — Optimize

Optimize existing specialties

Referrals arrive with completed workups, allowing specialists to focus on diagnosis and treatment rather than intake — increasing throughput without adding staff.

02 — Offload

Offload excess demand

Redirect lower-acuity visits to PCP clinics powered by Pointwell, reducing specialist backlog while retaining patients and downstream revenue in-system.

03 — Staff

Integrate an in-house APP

Deploy an NP or PA to bridge specialty gaps, retain patients, and generate immediate revenue — without full specialist recruitment costs or timelines.

04 — Grow

Generate new specialty demand

Attract new patient volume from PCP clinics, filling specialist schedules and preventing backlog from forming in your main specialty department.

For APPs & PCP Clinics

Pointwell lets advanced practice providers do more — and earn more.

01 — Scope

Practice at the top of your license

Pointwell's codified pathways are designed for high APP compatibility, enabling NPs and PAs to perform meaningful diagnostic work — increasing utilization and professional fulfillment.

02 — Care

Own the specialty connection for your patients

Rather than sending patients out and losing the thread, Pointwell-enabled PCPs and APPs stay at the center of the care journey — coordinating workup, visit, and follow-up in one place.

03 — Revenue

Share in specialty care economics

Pointwell's model includes revenue participation for APP providers involved in specialty encounters — creating direct financial upside tied to the value you help generate.

How Pointwell routes visit types

Each specialty's visit types are stratified by oversight model — keeping the majority of care in-system while routing only the most complex cases to the specialist directly.

APP with asynchronous specialist oversight
APP with synchronous specialist oversight
Specialist-direct (outbound referral)
Routine
Follow-up
Lab Review &
Monitoring
Medication
Adjustment
Initial
Evaluation
Complex Case /
Acute Flare
Managed by demand partner

Visits handled by APP — with async or sync specialist oversight — are managed entirely by the demand partner (health system / PCP clinic), including all downstream labs, prescriptions, imaging, and follow-up care.

Managed by specialty supply partner

The most complex, high-acuity cases — requiring specialist-direct management — are routed to the specialty supply partner, delivering higher-LTV patients where specialist expertise is most needed.

Visit type distribution is illustrative. Actual stratification is defined collaboratively with each health system's specialist leadership during the codification phase.

Target specialties

Where the need is greatest and the model fits best.

Pointwell targets specialties with significant hospital coverage gaps, high APP (NP/PA) suitability to perform the diagnostic workup, and large underserved patient populations.

Specialty
Hospital coverage gap
APP compatible
Rheumatology
~1,530 Gap Hospitals (85% of rural)
80%
Dermatology
~1,440 Gap Hospitals (80% of rural)
93%
Endocrinology
~1,350 Gap Hospitals (60% of rural)
73%
Gastroenterology
~990 Gap Hospitals (55% of rural)
87%
Nephrology
~810 Gap Hospitals (45% of rural)
93%
Pulmonology
~1,080 Gap Hospitals (60% of rural)
73%
Revenue model

Three revenue streams. Aligned incentives across the care team.

Every Pointwell encounter generates value across three distinct streams — each allocated to the party whose contribution created it. The model is built on established billing infrastructure, not novel reimbursement pathways.

PCP

PCP / APP Visit Revenue

Standard E/M visit reimbursement generated by the APP or PCP during the primary care encounter. All revenue flows directly to the APP/PCP location — structured identically to any primary care office visit.

TC/PC

Specialty Visit Revenue

Specialty encounter reimbursement follows the standard CPT code Technical Component (TC) / Professional Component (PC) split, modeled on CMS rates. The PCP location bills the TC; the specialist bills the PC — each receiving the portion attributable to their role.

Rx

Prescription Drug Program Value

Where eligible, participating health system locations may access federal drug pricing programs on qualifying prescriptions generated through the care pathway. Value is shared across the health system, APP location, and Pointwell per mutually agreed rates.

Revenue stream
How it's generated
Who receives it
PCP / APP visitsPrimary care encounters
APP or PCP sees the patient for a primary care visit. Billed under standard E/M codes at the scope of the provider.
PCP / APP location100% retained
Specialty encountersCollaborative visits
Specialist joins the prepared visit virtually. TC billed by the PCP location; PC billed by the specialist — split follows CMS component methodology.
PCP location (TC)
Specialist (PC)Split per CPT component
Drug program valueQualifying prescriptions
Specialist-initiated prescriptions fulfilled through eligible covered entities generate drug pricing program value on qualifying scripts.
Health system, APP location & PointwellShared per agreed rates
The team

Built by operators who scaled healthcare infrastructure before.

The founding team has a proven track record building and exiting a healthcare technology company — growing it from concept to 70M users and a successful acquisition by a publicly traded health company (NASDAQ: GDRX).

🏆
Fierce Healthcare
Innovation Award — Winner
2023 · Awarded to RxNXT
🥇
MedTech Breakthrough
Medication Payments Innovation Award
2024 · Awarded to RxNXT
🤝

Backed by Austere Moose Partners — a venture studio founded by the co-founders of GoodRx, who built one of the most widely adopted consumer health platforms in the US. Their operational experience in healthcare distribution and health system partnerships is directly relevant to Pointwell's model.

Common questions

Questions we hear often.

What specialties does Pointwell support on day one? +
Pointwell launches with three Tier 1 specialties: Rheumatology, Dermatology, and Endocrinology. These were selected for their long wait times, high APP compatibility for diagnostic workups, and demonstrated need in the rural hospital market. The platform is designed to expand to any specialty whose diagnostic protocols can be codified — including Gastroenterology, Nephrology, and Pulmonology in Tier 2.
Does Pointwell replace specialists with nurse practitioners or physician assistants? +
No — and this is a core principle of the Pointwell model. Specialists remain central to care and continue to interact directly with patients. Pointwell partners with specialists to codify their own visit types and diagnostic protocols, then enables APPs and PCPs to complete that workup ahead of the specialist visit. The specialist reviews the workup, joins the visit (virtually, live or async), and delivers the diagnosis and care plan. APPs extend specialist reach — they don't replace specialist expertise.
How does billing work? +
Visits bill under established E/M and telehealth codes — a PCP or APP visit (Technical Component) plus specialist review (Professional Component). Medicaid and Medicare telehealth parity in target rural states supports the reimbursement model. Pointwell earns recurring platform and MSO fees on every encounter, structured as a take-rate on generated revenue rather than a fixed SaaS license.
What does implementation look like for a health system? +
Implementation starts with a codification phase, where Pointwell works directly with the health system's specialist leadership to define visit types, diagnostic pathways, and workup protocols for each targeted specialty. This phase produces a proprietary clinical taxonomy that becomes the foundation of the Pointwell workflow inside that system. From there, the platform integrates into existing EHR and referral workflows. Pilots are structured as bi-directional deployments — testing both the supply of specialists and the demand from PCP/APP clinics simultaneously.
How does Pointwell ensure clinical quality and specialist oversight? +
Clinical governance is built into the platform structure. All diagnostic pathways and visit types are reviewed and maintained by specialist department leadership, ensuring alignment with current clinical standards. An expert Clinical Advisory Board — composed of specialty department leaders from partner health systems — oversees and sustains the clinical taxonomy, ensuring ongoing accuracy and cross-specialty alignment. Specialists approve all visit type classifications and participate directly in collaborative visits.
How does Pointwell fit into existing EHR workflows? +
Pointwell is designed to integrate alongside — not replace — existing EHR systems. The platform adds specialty-pathway intelligence at the point of referral, surfacing the AI-recommended visit type and diagnostic checklist within the PCP's existing workflow. During the partnership and codification phase, Pointwell works with health system IT and clinical operations teams to ensure the integration is seamless and adds minimal friction for providers.
Get in touch

Bring specialty care back in-system.

Whether you're a health system closing an access gap, a specialist group looking to extend your reach, or an APP clinic ready to practice at the top of your license — we'd like to hear from you.

Tell us a bit about your organization and what you're looking to explore. Our team will follow up directly.

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