Chronic Care Management

About Chronic Care Management Android App

HUBCHART™ is the first HIPAA compliant patient centered collaborative care group messaging app. The patient group chat platform, called PCG (Patient Care Group), is an easy and efficient way for the health care team to relay, coordinate and record valuable patient info. The easy-to-use patient and caregiver interface makes it a perfect platform for patient to join the care collaboration.


MAIN USES OF HUBCHART™ IN HEALTHCARE:

1. Medicare Non Face to Face(non F2F) services
Chronic Care managment
Transitional Care managment
Non F2F pre/post visit (CPT 99358)
Care Plan Oversight

2. Patient Centered Care Coordination by HMO/IPA
3. Patient Centered Medical Home
4. Complex case management and DC planning
5. Risk Management and Risk Stratification

What is CCM?


Chronic Care Management (CCM) is a non face-to-face healthcare service provided to medicare beneficiaries who have multiple chronic illness. In chronically ill patients, the healthcare crisis happens in between office visits and thus, leading to hospitalizations. The brief once a month doctor’s visit often doesn't capture the fluctuations of signs and symptoms of their illness. Thus, the goal of CCM is to provide ongoing care by means of frequent interactive communication and collaboration by healthcare team members, patients and family to prevent acute exacerbation/decompensation of a chronic medical condition, or functional decline. (https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/chronic-care-management.html)


Why HubChart is perfect for CCM?

HubChart™ makes it easy to maintain and share care plans, manage transitions of care , case management, and coordinating and sharing patient health information timely within and outside the practice anytime.
Unlike EHR, the instant messaging function of Hubchart make it a very efficient tool for real time care collaboration. And unlike other group chat apps, the group members on Hubchart require identity verification and are restricted to care team members only. The group members can be added by invitation only and are managed and controlled by group owner and group admins. The Chart is a patient named group and the conversation of the group members are centered around the care and well being of the patient. The patient centered groups are problem focused and the responses are highly specific and solution driven. 


CERTIFIED EHR VS HubChart

HubChart's data inputs comprise of real interactive communication by the Care Team. Anytime a care team member sends any essential information on the care team chats, it can do so instantly anytime, anywhere. It's like an EHR on call 24/7 with sequential care events. And each message or query has a corresponding reply. Thus, the data inputs are natural, conversational and meaningful. 

EHR, on the other hand, is designed for structured encounters that follow a certain rigid format like the HPI and SOAP note. Also, in traditional EHR, the author of the note is the only source of data while the other team members, oftentimes, has a “view only” option or an option to put addendum notes.