Case Study — CareAxis

Telehealth Operations Platform

Scaling From 200 to 8,000 Virtual Visits Per Month Without Adding Headcount

40x telehealth volume growth through operational automation and workflow intelligence

Industry

Healthcare — Telehealth Provider

Timeline

14 weeks

Team

7 engineers

Tech

Daily.co + Node.js + React

The Challenge

A telehealth provider processing 200 virtual visits per month had reached the ceiling of what their manual operations could handle. Scheduling, provider routing, pre-visit intake, documentation, and billing all required individual staff touch points. Scaling to 8,000 visits per month would require 40x the staff — economically impossible.

Our Approach

How We Solved It

Provider Matching Engine

Built an intelligent provider matching system that routes patients to available providers based on specialty, licensure by state, wait time, and patient history — eliminating manual scheduling coordinators.

Automated Pre-Visit Intake

Patients complete clinical intake, consent, insurance verification, and payment collection via a mobile-optimized pre-visit flow that feeds directly into the provider's chart before the visit begins.

AI-Assisted Clinical Documentation

Ambient AI transcription during video visits generates a structured clinical note draft in SOAP format that the provider reviews and signs — reducing documentation time by 68%.

Automated Post-Visit Operations

After each visit, the platform auto-generates the billing claim, sends the after-visit summary to the patient, schedules follow-up reminders, and routes any lab orders to the appropriate facility.

Engineering Process

How We Built It

Video Infrastructure at Scale

Built on Daily.co's WebRTC infrastructure with custom waiting room logic, provider queue management, and automatic failover to backup regions when latency exceeds 150ms.

State-Based Licensure Routing

Real-time licensure validation ensures patients are only matched with providers licensed in their state, with automatic fallback routing when the primary provider becomes unavailable.

HIPAA Video Compliance

All video sessions are encrypted end-to-end with BAA-covered infrastructure. Session metadata and AI transcripts are stored with field-level encryption and 7-year retention per HIPAA.

Architecture Decisions

Key Technical Choices

Headless Video Over Full-Stack Video Platform

Used Daily.co's WebRTC API rather than a full telehealth platform, giving us control over UX, workflow, and data while inheriting enterprise-grade video reliability.

Ambient AI Over Dictation

Ambient transcription (AI listens during the visit) rather than post-visit dictation was adopted by 91% of providers vs 38% for dictation — the workflow fit was the key.

Event-Sourced Visit State Machine

Each visit is modeled as an event-sourced state machine (scheduled → intake → waiting → active → completed → billed) enabling complete audit trails and resume-from-state on connectivity drops.

Results

What We Delivered

40×

Visit Volume Scale

72%

Reduction in Ops Overhead

99.7%

Video Session Reliability

HIPAA

Compliant End-to-End

Solution Blueprint

How It All Fits Together

Video Infrastructure

Daily.co WebRTC
Multi-region failover
End-to-end encryption

Clinical Operations Layer

Provider matching engine
State licensure routing
AI ambient documentation

Revenue Operations Layer

Automated claim generation
Insurance pre-verification
Post-visit care automation

Lessons Learned

What We Improved

Automate Post-Visit, Not Just Pre-Visit

Most telehealth platforms focus on the pre-visit intake experience. The 40% of time saved by automating post-visit billing and documentation was entirely overlooked until we measured it.

Provider Experience Drives Patient Experience

When providers spend less time on documentation and routing, they spend more time with patients. Patient satisfaction improved most from the AI documentation reduction, not the UX improvements.

Build for Connectivity Failures From Day One

15% of telehealth visits experience at least one connectivity event. Resume-from-state architecture meant zero lost visits rather than requiring patient re-check-in.

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