Our Community Health Initiative strives to build collaboration, between technology enabled Community Based Organizations (CBO's) that improve health, with local healthcare providers and social support networks.
PARTICIPATE
Participate with a leadership role in the local healthcare community.
ACCESS
Establish a referral network for programming and allow for expansion of services delivered to the community.
INVESTMENT
Control healthcare costs through care management while increasing caregiver's revenue to improve community health and wellness.
DATA
Collect and share patient data in a HIPAA compliant fashion to allow multidisciplinary collaboration.
“Community Integrated Health aims to intentionally strengthen the relationships between traditional healthcare systems and Community-Based Organizations (CBO’s) in order to help all community members live their healthiest lives”
- NC alliance of medical partnership summit 9/6/17
SOFTWARE FEATURES
DIGITAL REFERRAL
Enable digital referrals of eligible individuals with the services that will improve community health.
PROGRAM MANGEMENT
Deployment of OCHI’s purpose built EHR enabling the creation of programs, schedules, patient enrollment, care team assignments, and outcomes reporting.
PATIENT ASSESSMENT
Offer both self and care team administered assessments to monitor and measure outcomes for trending and reporting.
INTEROPERABILITY
Leverage the digital transfer of data to support PCPs offering patients the highest quality care.
REVENUE
Submit medical claims for payment with OCHI's integrated billing functionality.
1. Primary Care Provider
- EHR initiated referrals of patients with chronic care conditions.
- Actionable data allowing updates to their patient’s care plans.
- Revenue generation while increasing patient care services.
2. Local CBO
- Proprietary OCHI EHR used for program creation and patient care management.
- Patient information collected and stored in HIPPA compliant database.
- Interoperability for bilateral data transmission with Stakeholders.
3. NC CARE360
- Repository for identifying those in need of support for SDOH.
- Digital data sharing from their database to CBO services.
4. Community at large
- Services that provides health related programs and interventions.
- Support network of care managers, health coaches, and social services.
- Improvement of Quality of Life.
In an effort to support Primary Care Providers, Our CHI offers services and technology that enable the efficient workflows for the referral and delivery of of evidence based programs, software, and services:
Diabetes Prevention Program
Behavioral Health Integration
Chronic Care Management
Wellness Programs
SDOH Case Management
Remote Patient Monitoring
Telemedicine with Remote Vital Devices
Remote Therapeutic Monitoring
For more information please contact:
Franklin Walker, MBA
(919)-833-3836
Email: fwalker@ncmedsoc.org
