Chronic Care Management (CCM)
Chronic Care Management Solution
CCM – Chronic Care management enhances patients, health outcomes, engagement, and satisfaction, and encourages preventive care. For healthcare providers, chronic care management fosters efficient resource use, and improved care coordination, and offers financial incentives through specific reimbursement codes. Let SAYF MEDICAL provide a patient-centric experience with physician-driven models to improve patient outcomes while driving additional revenue models for your healthcare practice.
SAYF MEDICAL’S Coordinators will provide a seamless experience for your patients, providing a care journey that will improve patient engagement.
- 33+ Chronic Disease Sets uploaded to support education, patient symptom management, and vital intake allowing you to serve a large population with a combination of chronic diseases that create positive outcomes for your patient population
- Enrollment Support with In-App enrollment features as well as Dedicated Project Management and ongoing support
- Video, SMS Text, In-App Chat & Phone Support 24/7 simply using the App from the Google or Apple Store
- Calls and or Video calls integrating remote patient monitoring, lab vitals, and medication management to provide counseling and education to improve outcomes for each call
- Education and oversight for patients who have acute changes in care with the ability to create appointments for clinic visits that include appointment reminders SMS Text
- Weekly medication chat to update changes with the care coordination team to ensure accuracy
- Real-time patient monitoring features include Pian Score, Glucose, Blood Pressure Heart Rate, Weight, & O2 Saturation integration through blue tooth devices available
- Meal logging to make healthy choices about food intake and calorie outcomes
- Notes and billing data use updated real time to include copy features for easy transfer of information to primary EMR or EHR
- Care Coordination support is available to ensure you have a full model in place on day one to grow your patient care model without disruption (additional costs will apply)
- eClinicalWorks API Integration: Official HL7 connectivity for streamlined operations.
