Care Management Programs & Program Design

Programs optimized for better patient and practice outcomes

Designed by physicians and made possible by our scalable platform, we provide a full array of care management programs for total patient-centered care. We support protocols for over 400 patient conditions and for the Medicare programs below. If you don’t see what you’re looking for, we can design it for you.

We offer the only outcome-driven design program that combines a breadth of experience across healthcare entities and conditions, to deliver scalable, customized programs that address your specific practice or organizational goals.

Time tested, future focused

With over 800 successful implementations of Medicare-covered programs, we’re equipped to stay ahead of what’s next in technology, regulation, AI and reimbursement – so health systems, payors and practices are proactive and efficient.

Value-Based Care

Our platform was built to help health systems, ACOs and others to achieve better health outcomes for patients, improve the quality of care, and reduce healthcare costs.

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Transitional Care Management

Our TCM programs provide clinical care and digital applications for patient education, improved medication adherence, early intervention, and continuity of care across providers and settings.

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Remote Therapeutic Monitoring

By improving visibility to health-related outcomes, such as pain scores, patient reported symptoms and therapy adherence, our RTM programs support providers in identifying issues, timely intervention, and adjusting the patient’s care plan accordingly.

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Remote Patient Monitoring

Our RPM programs go beyond just collecting data. We take a comprehensive approach to remote patient monitoring by customizing vitals ranges and alerts for patient care and creating custom workflows for our customers. This can include enrollment to logistics management, patient education and billing integration.

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Principal Care Management

When patients are enrolled in PCM programs, our solutions identify patient eligibility for other beneficial programs, like Remote Patient Monitoring or Transitional Care Management. These programs work better together to provide unified patient-centric care.

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Diabetes Care

For providers, it is easier than ever to continuously monitor patient glucose levels as part of an overall care management strategy. Regardless of the CGM device diabetes patients use, our platform actively uses patient data to help physicians make informed clinical decisions.

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Chronic Care Management

Our CCM programs enable on-going patient support and guidance from a care manager, digital and telephonic communication, and individualized care plans and health content. Patients gain access to applications for personal health tracking, goal setting, and secure communication with their care manager.

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Behavioral Health Integration

Our programs accomplish what Medicare has designed BHI programs to do – bridge the gap between primary care and behavioral health. Patients will navigate through one of our proprietary behavioral health modules utilizing validated rating scales, designed by a leading behavioral health practitioner.

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Annual Wellness Visits

Our care management software, RevCare, is a key contributor to successful AWV programs, enabling automatic scheduling and reminders and built-in health risk assessments. Turnkey clinical support is available to help primary care providers execute AWV programs.

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Remote Care Program design

Our experienced design architects have developed programs for clinics, healthcare systems, Medicare, primary care and more. Our process is outcome driven, addressing the goals of, patients, clinicians and payors.

Our clinical team works with each client to adapt programs for the target population or to support practice goals, adjusting as needed at the practice, provider, and patient level – by segment or individually by patient.

  • Design-build customized patient engagement programs to match any initiative or focus
  • Custom escalation protocols for out-of-range vitals and alerts
  • Guidance and procurement for the right devices for your patient population
  • Workflow and workforce planning, customizable user-based permissions
  • Customizable communication preferences at the patient, provider, and practice level