Integrated Care Management Services

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The key component for our success is having an all-encompassing platform for treating a patient in a whole body & mind approach.  Under one roof, comorbidity care plans marry with pharmacy & behavioral health to treat patients at our best!  The use of telemedicine, RPM devices, & data analytics drastically improve patient outcomes & drive costs down. Our success is determined by the right amount of technology & personal touchpoints by healthcare providers, caregivers & patient care coordinators.

Our Platform will aid in the controlling entity assessing each patient's healthcare needs and formulate a care plan based on severity of disease state and best treatment standards.  The plan will define the type of care;  chronic, transitional, or ancillary (PCP) care and what impacts or hurdles care management may present. A plan for care, oversight, telemedicine & RPM, pharmacy, behavioral health, along with community outreach will all be factored into our solution for better care at the Hospital, Specialty and Primary Care Settings. ACO's will have a transparency in real time of their patient direction of care.

Specialists & Primary Providers are notified when their assigned patient is admitted to ED, and transitional or SNF care is needed.

Consultation ability between Primary Care Physician, Specialist Physician, and Hospitalist may be documented in our system and care follow-on managed by a Care Coordinator. 

 • CONTRIBUTOR - Hospitals send to State ENS (CMS requirement

•SUBSCRIBERS receive real-time ENS (Insurance plans, ACOs, MSOs, IPAs, TPAs, physician organizations

Our care coordination is a patient and family-centered, team-based activity designed to assess & meet the needs of patients, while helping them navigate effectively & efficiently through the health care system.  We address potential gaps in meeting patients' interrelated medical, social, developmental, behavioral, educational, & informal support system in order to achieve optimal health.

Using telemedicine in our platform improves a patient's health by permitting two-way, real time interactive communication between the patient, and the physician or practitioner from a distant site. This electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video.

Being rated as one of the healthcare marketing trends for 2021, Benefits of using RPM in healthcare include:

• Improved patient outcomes (49%) 
• Improved compliance rates (44%)
• Patients’ interest in their health (42%).

Behavioral health is a person’s state of being & how their behaviors & choices affect their overall health and wellness. Behavioral health disorders are illnesses that are precipitated or perpetuated by your conscious decisions & which you are unable to resist the urge to repeat, despite negative consequences. Our platform may facilitate an appropriate encounter by a partner in Behavioral Health.

Our platform integrates with a PBM built on the approach of lowest cost purchasing & clinical price selection that works smarter to deliver greater results. With the PBM in place, our PBM tools – such as utilization management, formulary, and direct patient delivery – perform at a higher level to improve patient health, engagement, and satisfaction.

The key component for our success is having an all-encompassing platform for treating a patient in a whole body & mind approach.  Under one roof, comorbidity care plans marry with pharmacy & behavioral health to treat patients at our best!  The use of telemedicine, RPM devices, & data analytics drastically improve patient outcomes & drive costs down. Our success is determined by the right amount of technology & personal touchpoints by healthcare providers, caregivers & patient care coordinators.

The key component for our success is having an all-encompassing platform for treating a patient in a whole body & mind approach.  Under one roof, comorbidity care plans marry with pharmacy & behavioral health to treat patients at our best!  The use of telemedicine, RPM devices, & data analytics drastically improve patient outcomes & drive costs down. Our success is determined by the right amount of technology & personal touchpoints by healthcare providers, caregivers & patient care coordinators.

We utilize data analysis to build models, aggregating data, testing & applying the data on individuals, assessing the outcomes, by refining the models.  We then are able to create predictive outcomes.  Analysis of Social Determinants, Claims Data, Pharmacy Orders, Remote Patient Monitoring, and Patient Exam Risk Scores are used to formulate realtime outcomes.  Claims data only reports simply won't provide the outlook desired.  Our goal is to deliver a prevention model for furthering disease states and providing better outcomes.

We offer a range of programs for uninsured and underserved individuals and families.  Our partners in comorbidities have all focused their efforts to treat patients in a holistic approach of total care.  We work in FQHCs, Community Centers, Churches and religious centers.  Our team is also engaged in a Mobile Outreach Program, Community Health Workers, as well as transportation for clinic visits.