CHRONIC CARE POPULATION MANAGEMENT
Transforming your EMR into a Population Management Tool
We “interoperate” with your EMR to add a chronic care “patient layer” over the current billing-centric experience. Be able to answer questions like “are my patients getting better, and who isn’t?” Our programs in Heart Health, Diabetes and COPD put you at the center of their coordinated care management.
Patient Programs that transform “instruction” into “guidance”
There is a large gap between great physician instruction and strong patient action. Our chronic condition mobile programs help patients build core skills in diet, physical activity, adherence and logging. Helping a physician move from telling a patient “what” to do, to “how” to do it.
This program is free to providers who claim patients
CMS introduced a new coordinated care incentive in 2015 (calculate your opportunity below) that is available to the the first provider in a care circle that claims a patient. Jump on this innovation trend before another provider claims your patient. Our programs are certified to qualify you for the CMS incentive and put you at the center of the coordinated care.
Traditional EMR screen,five keystrokes from adding a sub-billing code, thousands from understanding the health of your patients
The EMR patient layer sits on top of your existing EMR, creating a window into your chronic care population
Incorporates third party assessment tools like the Archimedes Heart Health Assessment, American Diabetes Association standards of care, or the US Preventive Services Task Force recommendations
Identify care opportunities and vitals trends within your patient population
Monitor standards of care across your entire patient population (e.g., out of date bp readings)
Patient dashboard with summary of data collected from connected patients
Monitor your patients’ progress through their education and care plans
Keep track of your patients’ between-appointment blood pressure checks