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Industry Leading Healthcare Management Solutions
Step 1. Analyze Patient Population
We utilize the diagnosis codes captured in your EHR/Billing system to identify patients with 1 or more chronic conditions to participate in the Remote Physiological Monitoring (RPM) program. Using the categories provided by the Centers for Medicare and Medicaid Services (CMS), listed below, and an automated in-house proprietary process, our team generates a Suggested Patient List. The report contains existing patients who have been diagnosed with 1 or more chronic conditions.
Step 2. Vet Suggested Patient List
The Suggested Patient List is then made available to you and your staff. Our team asks that you spend a few minutes to review the suggested list and identify any patients that you feel may not be a good fit for the program.
Step 3. Our Onboarding Team Delivers Devices and Training
Once your staff has approved the Suggested Patient List, our Onboarding Team will begin contacting the patients to verify their willingness to participate in the program. As patients acknowledge they want to be part of the program, our Onboarding Team will begin shipping the necessary products to each patient and then scheduling individual or group training sessions as necessary.
Chronic Conditions Recognized by CMS
CMS has recognized the following diagnosis as chronic conditions that should be documented and managed using EITHER a Chronic Care Management (CCM) or a Principal Care Management (PCM) program:
- Alzheimer’s disease and related dementia
- Arthritis (osteoarthritis and rheumatoid)
- Asthma
- Atrial fibrillation
- Autism spectrum disorders
- Cancer
- Cardiovascular disease
- Chronic obstructive pulmonary disease (COPD)
- Depression
- Diabetes
- Heart failure
- Hypertension
- Infectious diseases such as HIV/AIDS
- Ischemic heart disease
- Osteoporosis
- Chronic kidney disease
- Schizophrenia and other psychotic disorders
- Stroke
- In addition, obesity is considered a chronic condition. Chronic conditions are long-term health conditions that persist over an extended period and often require ongoing medical attention and management. Obesity is characterized by an excess of body fat and is associated with various health risks, including cardiovascular disease, diabetes, certain types of cancer, and other related conditions.
- The classification of obesity as a chronic condition acknowledges that it typically requires ongoing efforts for prevention, treatment, and management. Healthcare providers may use various approaches, including lifestyle modifications, dietary changes, increased physical activity, and in some cases, medical interventions, to address and manage obesity. Additionally, because of its potential impact on other health conditions, managing obesity is often an integral part of overall healthcare strategies and chronic disease management programs.
- The classification of obesity as a chronic condition acknowledges that it typically requires ongoing efforts for prevention, treatment, and management. Healthcare providers may use various approaches, including lifestyle modifications, dietary changes, increased physical activity, and in some cases, medical interventions, to address and manage obesity. Additionally, because of its potential impact on other health conditions, managing obesity is often an integral part of overall healthcare strategies and chronic disease management programs.
Our Products & Services
Principle Care Management
(RCM)
Principal Care Management (PCM) is a healthcare service designed to support patients with a single, high-risk chronic condition. The focus of PCM is on providing structured care and coordination to improve health outcomes. Here are key aspects of PCM: Structured Assessment, Care Planning, Regular Monitoring, and Coordination of Care.
Chronic Care Management
(CCM)
CCM involves a coordinated and comprehensive team approach to identify and comprehensively manage multiple chronic conditions for each patient. With the goal being to improve their individual health outcomes which in turn will raise their Quality of Life (QoL).
After identifying each patient that has 2 or more chronic conditions, the CCM Plan will help us determine which wireless medical device(s) will best support the patient’s achievement of their daily and long-term goals.
Transitional Care Management
(TCM)
If your practice accepts responsibility for a patient’s care at the time of post-facility discharge (without a service gap), you should utilize a TCM Plan to assess and support treatment adherence, including medication management. In addition, RPM devices are used to provide real-time daily monitoring and reporting of vital signs.
Remember, each transitional care management plan should be tailored to the specific needs of each patient. Collaborate closely with patients, healthcare professionals and utilize available resources.
Remote Physiological Monitoring
(RPM)
Wireless (4G) medical devices, wearable sensors, and mobile healthcare applications are used to capture and transmit a patient’s vital signs, symptoms, and other health-related information directly to healthcare providers.
We utilize RPM devices to support patients with 2 or more chronic conditions (CCM) and patients with 1 chronic condition that dictates using a Principal Care Management or PCM Plan. By leveraging PCM, we hope to lessen the likely hood of complications or the development of additional chronic condition(s).
