Chronic Care Management Software

Our Chronic Care Management Software is a cloud-based, modular technology platform.  It was developed to meet all the electronic care plan requirements for CPT code 99490.  The intuitive design helps providers, care teams and administrators leverage a sophisticated engine to identify and manage patients with 2+ chronic conditions. The software technology is the ideal platform to create and manage care plans for these identified patients.  It includes feature rich capabilities beyond typical electronic care plan software.

Benefits and Features of Chronic Care Management Software

  • Chronic condition analytics and predictive modeling
    • Johns Hopkins ACG Model Engine
    • Patient Risk Stratification and Program Assignment
  • 24/7 system accessibility to all care team member
  • Comprehensive Assessments
    • Whole person model
    •  Condition specific assessments
    • Complex case management
    • Behavioral health
    • Medication adherence
    • Smoking cessation
    • Care Transitions
  • Individualized electronic plan of care (tracking issues, goals and interventions)
  • Integration with evidence-based guidelines
  • Optimized care manager workflow engine
    • Daily work queue
    • Patient Dashboards
    • Patient level claims history
    • Patient level comprehensive clinical profile
    • Clinical tracker (biometric data)
    • Session notes
    • Correspondence
    • Attachments
    • Drug alerts
    • Provider Channeling
  • Secure Messaging
  • Health education materials
    • By condition
    • By medication
  • Provider/patient portals
  • Reporting Capabilities
    • Population assessments
    • Biometrics reports
    • Billing reports