We help increase physician practice and organization revenue by creating billable Chronic Care Management (CCM) episodes, increasing visits for management of chronic disease and ensuring that every eligible patient has AWV and E&M visits.
There are other benefits of CCM that can lead to:
❏ Measuring for better health outcomes including ACO quality metrics
❏ Focusing on disease prevention
❏ Reducing demands on your staff
❏ Helping manage and improve chronic diseases
❏ Fostering a more ­efficient and coordinated health care system


You will not need to invest in additional financial or labor resources. We provide a turnkey HIPAA compliant cloud-based software along with Care Coordinators. We do not charge an implementation or a regular subscription fee, thereby further minimizing your cost. This allows your practice to continue to operate without requiring additional investment.


Our information is presented in a way that is understandable and allows you to identify areas of opportunity – Gaps in chronic care, patient’s risk of developing chronic disease and gaps in preventative care. The process includes assessment, planning, facilitation, care coordination, evaluation, and advocacy in order to meet the comprehensive medical, behavioral health and psychosocial needs of the individual while promoting quality and cost-effective outcomes. We also have a team of Care Coordinators that are trained to provide superior support to patients and their families by offering comprehensive care management services. We will work closely with your team to help improve your quality and patient engagement scores.


Our proprietary cloud-based software contains a robust provider and patient portal that allows information to flow through seamlessly. We provide the capability to have secure messaging, thereby reducing the amount of time spent on the phone. The patient portal allows the entire care team including family members to have visibility into the patient’s health and care plan. Our proprietary cloud-based software allows integration of wearables, coaching and wellness education.


We believe that an informed patient will be better engaged in their care. Our proprietary technology provides tools for seamless communication such as push notification and SMS to proactively communicate with patients. Our software will enable patients to better care for their chronic condition and involve caretakers by providing information regarding care gaps transparently to the entire team. We have developed targeted programs that allow for customization to meet patient-specific needs. The overall aim of each program is to provide appropriate interventions to improve the patient’s quality of life and care by promoting acceptance of self-management of his/her illness via frequent personalized communication.