Whitney Health
The MCI Service Line
Differential diagnosis, results delivery, and ongoing monitoring for mild cognitive impairment.
The MCI service line is built around a staged clinical pathway that moves each patient from initial population screening or physician triage through differential diagnosis, results delivery, and ongoing diagnostic, therapeutic, and symptom monitoring across the full course of their care.
Entry Points
The pathway has two entry points. Every patient who enters the service line, regardless of entry point, moves through the same evaluation and monitoring infrastructure.
Path A
Annual Screen
Patient completes a validated subjective cognitive decline (SCD) questionnaire (self-administered, no technician required).
SCD endorsement → patient proceeds directly to Stage 1: Structured Intake for evaluation.
No SCD endorsement → brief automated cognitive assessment (CPT 96146), self-administered, no supervision required. If no prior baseline on record, patient is invited to complete a full baseline benchmark (self-administered, self-pay).
Path B
Physician Referral
Referring clinician (or staff member) assigns an assessment battery via the Whitney Health platform. If a patient lacks capacity, the physician will also enter information for the patient representative who will be the point of contact.
Patient (or rep) receives an email, completes consent and capacity screen. If a patient lacks capacity and have not yet done so, they are prompted to invite a patient representative.
Proceeds to Stage 1: Structured Intake, for evaluation.
Process Overview
01
Patient
Consent + Capacity Screen
02
Patient
Intake + Questionnaires
03
Technician
Staged Assessment
04
Whitney Health
Transcription, Scoring + Annotation
05
Neuropsychologist
Score Review + Preliminary Report
06
Neuropsychologist
Patient Feedback + Care Planning
07
Patient
Longitudinal Monitoring
The MCI Assessment Process
00
Physician
Physician Referral
The referring clinician, or their staff, logs into the Whitney Health platform and assigns an assessment battery.
The clinician selects the service line, delivery modality (in-office or telehealth), supervision arrangement, and neuropsychologist review path, and enters any relevant clinical context. If the patient is known to lack capacity, the physician also enters the patient representative’s information at this stage.
The patient (or representative) receives a secure email with a registration link.
01
Patient
Consent and Capacity Screen
The patient receives an email with a link that leads them to multi-factor identification, consent to by evaluated by Whitney Health and a capacity screen.
The patient (or the patient representative) consents to evaluation by Whitney Health. Upon consent, self-consenting patients are screened for capacity. Should a patient representative consent on the patient's behalf, the patient representative answers questions that confirm an understanding of Whitney Health evaluations, and privacy and data policies.
02
Patient
Intake and Health Questionnaires
Intake is completed by the patient or patient's representative. A trained technician reviews the completed intake with the patient at the start of the supervised session.
Intake covers demographics and contact information; medical history and current diagnoses; mental health status; cognitive status; physical status relevant to assessment performance; current medications; lifestyle factors; family medical and neuropsychiatric history.
Questionnaires include: Familiarity with Mobile Devices; Visual, Hearing and Fine Motor Acuity; Subjective Cognitive Decline; PHQ-9; MADRS (where appropriate); Lifestyle Questionnaires (exercise, diet, substance use, sleep habits); GADS-7; Modified MPAI; ADLS and IADLS (where appropriate); and CDR (where appropriate).
Where appropriate, the patient representative completes caregiver questionnaires about the patient’s status, separately from patient questionnaires.
03
Technician
Staged Assessment
Assessment occurs in several stages under the supervision of a trained technician either in-office or via Telehealth.
Intake review: the trained technician confirms intake responses provided by the patient or patient representative.
Patient interview: recorded and saved for review. It includes chief complaint, complaint history, and lifestyle questions.
Assessment: designed to identify MCI and differentiate MCI subtypes. The battery covers memory, attention executive function, processing speed, speech, language, motor function, and mood. Specific task interactions are recorded (voice, behavioral responses, and touchscreen interaction), encrypted at the point of capture, and transmitted to the Whitney Health platform for processing. No data is stored on the patient’s device. Sessions that do not meet technical or environmental quality standards are flagged before entering the scoring pipeline.
Your practice’s contract pre-determines whether the trained technician who supervises assessment is employed by Whitney Health employee or your organization.
04
Whitney Health
Transcription, Scoring and Annotation
Speech-to-text transcriptions are reviewed, edited, and annotated by Whitney Health staff who flag technical anomalies for review by engineers and behavioral questions are identified and described, creating a navigable clinical record for the reviewing neuropsychologist.
05
Neuropsychologist
Score Review and Preliminary Report
The neuropsychologist reviews the complete record: medical history, medications, family history, questionnaire results, interview data, performance scores, and evidence-based disease likelihoods. Rather than reviewing raw recordings linearly, the neuropsychologist navigates directly into recordings by clicking scores of interest; a more complete and referenceable observational record than real-time in-person review, where observations are unrepeatable.
The neuropsychologist writes a preliminary clinical report within the Whitney Health platform, integrating quantitative scores with behavioral observations from the annotated recording and transcripts. The preliminary report includes differential diagnostic interpretation, normative comparisons, and initial clinical recommendations.
The report is not finalized at this stage. It serves as the clinical hypothesis the neuropsychologist brings into the patient encounter.
07
Monitoring
Longitudinal Monitoring
Whitney Health’s longitudinal monitoring system tracks each patient’s cognitive and functional status over time — across medications, rehabilitation, lifestyle interventions, and disease progression.
Monitoring serves three clinical functions:
Diagnostic monitoring: confirming or refining the initial diagnosis over time. For ACO and Medicare Advantage health systems, Whitney Health generates the MEAT-compliant documented clinical encounter required to recapture MCI as an HCC diagnosis each calendar year — preventing RAF score erosion and the revenue leakage that follows.
Therapeutic monitoring: tracking whether a clinical intervention is producing the expected functional response. For patients on anti-amyloid therapy, Whitney Health’s longitudinal sensitivity detects whether the medication response matches expected responder trajectories — and flags atypically slow response or sudden domain-specific declines that warrant physician review.
Symptom monitoring: tracking functional status continuously between clinical visits, generating alerts when the platform detects a change pattern that warrants attention. This provides a continuous functional signal between imaging time points — prompting the ordering physician to act rather than waiting for the next scheduled MRI window.
The platform’s patented architecture minimizes practice effects and statistically models expected retest trajectories from normative control data, so longitudinal change reflects genuine functional shift rather than anticipated improvement.
Ongoing Monitoring
Following the initial assessment and care planning, Whitney Health’s longitudinal monitoring infrastructure tracks each patient’s cognitive and functional status over time — across medications, rehabilitation, lifestyle interventions, and disease progression.
Diagnostic Monitoring: Confirming or refining the initial diagnosis over time. For ACO and Medicare Advantage health systems, Whitney Health generates the MEAT-compliant documented clinical encounter required to recapture MCI as an HCC diagnosis each calendar year — preventing RAF score erosion and the revenue leakage that follows.
Therapeutic Monitoring: Tracking whether a clinical intervention is producing the expected functional response. For patients on anti-amyloid therapy, Whitney Health’s longitudinal sensitivity detects whether the medication response matches expected responder trajectories — and flags atypically slow response or sudden domain-specific declines that warrant physician review.
Symptom Monitoring: Tracking functional status continuously between clinical visits, generating alerts when the platform detects a change pattern that warrants attention. This provides a continuous functional signal between imaging time points — prompting the ordering physician to act rather than waiting for the next scheduled MRI window.
The platform’s patented architecture minimizes practice effects and statistically models expected retest trajectories from normative control data, so longitudinal change reflects genuine functional shift rather than anticipated improvement.
Anti-Amyloid Therapy Monitoring Protocol
Patients who enter the MCI service line and receive a diagnosis of amnestic MCI may be candidates for disease-modifying anti-amyloid therapy. Whitney Health provides a standardized monitoring protocol designed specifically for this indication — a direct continuation of the assessment and diagnostic pathway.
The Clinical Imperative
Anti-amyloid therapies carry significant clinical risk. Amyloid-related imaging abnormalities (ARIA) — microhemorrhages and edema — occur in a meaningful proportion of treated patients, with the highest risk in ApoE4 carriers. The current monitoring standard relies primarily on scheduled MRI windows.
Between imaging time points, subtle functional changes that may signal early ARIA or inadequate therapeutic response can go undetected. By the time the next MRI is scheduled, a clinically significant event may have progressed. Whitney Health provides a continuous functional signal between imaging time points.
What the Protocol Provides
Defined assessment cadence.
A standardized monitoring schedule aligned to anti-amyloid therapy treatment timelines. Scheduling, patient notification, and session assignment are automated. The ordering physician does not manage the monitoring cadence manually.
Specified battery at each interval.
A defined battery of interactive cognitive assessments and validated clinical questionnaires assigned automatically at each protocol interval — covering the cognitive domains most relevant to anti-amyloid treatment response and ARIA-related functional change.
Comparative score report at each monitoring point.
Every protocol interval produces comparative change over time across relevant measurements, delivered to the ordering clinician’s dashboard and EHR — not a digital score, but a clinical document suitable for the patient record.
Longitudinal tracking across the treatment course.
The platform maintains a complete longitudinal record of cognitive endpoints and functional status across the full treatment course. The platform’s patented architecture eliminates practice effects — every change in score reflects genuine functional change, not test familiarity.
Clinical Alert System
Whitney Health’s longitudinal monitoring detects two categories of signal that warrant physician attention between scheduled MRI windows:
Sudden Functional Decline: A sudden domain-specific functional decline — particularly in processing speed, attention, or executive function — that deviates from the patient’s established trajectory and may indicate an ARIA-related event.
Atypical Medication Response: A medication response that is tracking below expected responder trajectories across multiple monitoring intervals — indicating the therapy may not be producing the anticipated cognitive benefit and warranting clinical reassessment.
When either signal is detected, the platform generates an alert to the ordering physician. Unscheduled assessments can be assigned at any time through the platform to investigate further.
Patient Selection
Whitney Health’s differential diagnostic accuracy (AUROC 0.94 for aMCI) ensures that patients entering the monitoring protocol have been appropriately selected — reducing the risk of exposing non-candidate patients to ARIA risk. Patients diagnosed with non-amnestic MCI or late-life depression through the same assessment pathway are correctly identified as non-candidates before any treatment decision is made.
For ACOs and Medicare Advantage Health Systems
HCC risk adjustment requires that all chronic conditions — including MCI — be documented with MEAT-compliant specificity each calendar year. RAF scores reset each January 1st; conditions not recaptured annually drop from risk scoring entirely.
Whitney Health’s annual monitoring service generates the structured, neuropsychologist-authored clinical encounter required to satisfy this recapture requirement — supporting accurate HCC coding, defensible RAF scores, and population health documentation across your Medicare patient panel.
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