Our CHI endeavors to form a coalition that fosters single source collaboration between Community Based Organizations (CBO's) currently providing services that improve health, with local healthcare providers and social support networks

PARTICIPATE

Participate with a leadership role in the local healthcare community.

CREATE

Create a referral network for programming and allow for expansion of services delivered to the community.

INCREASE

Increase member revenue for health and wellness services including from Medicare and other Payers.

COLLECT

Collect patient data in a HIPAA compliant EHR to allow the Patient’s Care Team to access necessary data for reporting outcomes in addition to filing medical claims.

“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

OCHI_logoPOWEREDBY
OCHIdigReferal

DIGITAL REFERRAL

Imports data from Primary Care Providers (PCP) allowing for pushing patient data to the Our CHI EHR platform.

OCHIprogramManagement

PROGRAM MANGEMENT

Purpose built EHR Custom User Interface (UI) enabling creation of programs, schedules, patient enrollment, coach assignments, and outcomes reporting.

OCHIPatientAssessment

PATIENT ASSESSMENT

“Coaches” leverage the Our CHI mobile application for patient data entry, outcome trending and reporting.

OCHITransfer

PATIENT DATA TRANSFER TO PCP

Digital transfer of PCP critical MIPS/MACRA data directly from Platform EHR CCDA interface.

OCHIClaim

CLAIM SUBMISSION TO MEDICARE/PAYERS

Integrated billing software with certified medical billing staff will scrub and submit medical claims for payment.

1. Primary Care Provider

Primary Care Provider

  • Refers patients with chronic conditions to CBO
  • Referral is digital and directed to specific CBO program
  • Receives patient updates of vitals and level of paricipation
  • Determines on-going patient care plan based of CBO outcomes

2. Local CBO

LOCAL CBO

  • O-CHI application used to create & manage programs
  • Mobile app allows for patient assessments
  • Patient information stored in HIPAA compliant clinical database
  • Backend billing functionality offers claims submission
  • Collected data available for O-CHI reporting functionality

3. UNITE US Integration

  • Provides solution to digitally move patient data bi-directionally
  • Offers cloud based network to services supporting SDOH

4. CBO Trainer

CBO Trainer

  • Sees only participants information and programs they are assigned
  • Uses handheld tablets to perform attendance & assesses participation performance
  • Collects participants vitals and quantitative results

CBO's Offer Evidence Based Programs for Physician Referred Patients

Evidence based programs will improve overall health such as the ones below offered by YMCA's:

Diabetes Prevention Program

Livestrong

Healthy Weight and Your Child

Blood Pressure Self-Monitoring Program

Moving for Better Balance

Weight Loss Program

Enhanced Fitness Program

For more information please contact:

Franklin Walker, MBA

(919)-833-3836

Email: fwalker@ncmedsoc.org