CCM Care Coordination Software

Brilliant Medical’s Solutions Chronic Care Management (CCM) program employs a comprehensive, cloud-based software solution developed by clinicians for clinicians. Our CCM platform provides a centralized portal for high risk patients with multiple chronic conditions to easily access and share their health information with all providers, caregivers and family member they work with through a s single location.  Our comprehensive approach to chronic care management is the only solution needed for ACOs, large health systems, group practices, and solo practitioners. CCM also fully supports non-physician (nurse practitioners, physician assistants, etc.) practices.

Chronic Care Management Documentation & Time Tracking

Every interaction between patients, nurses, caregivers, and practices — as well as care plan development and updating — is time-tracked using “under the hood” architecture that quietly tracks all time spent on CCM and CPO each month. Practices have access to a robust reporting module where they can check their progress each month. At month’s end, practices can easily generate a list of all patients that met CCM or CPO time minimums. The list is given to the practice’s biller for billing each month. In case of audit, drill down of all time-tracked interactions can easily be shown to the auditor.

CCM Features & Benefits

  • Person-Centered Care Plan
    Comprehensive insight into a patient’s goals and status. Includes all Medicare required aspects, as well as important functional assessment tools. Accessible 24/7.
  • My Care Connector™
    A care sphere is built around each patient that includes connectivity between all stakeholders involved in a patient’s care. Ideal for ACOs and organizations working to build a highly connected care model.
  • My Wishes, My Words™
    This unique feature “puts goals in plain sight,” providing an important context of care direction in a patient’s own words.
  • Patient-Friendly Interactivity
    Our easy-to-use patient module is built with simple, one-click buttons, highly readable fonts and graphics, and more patient-friendly functionality.
  • Robust Reporting Dashboards
    Practices can run a number of analytics on their populations, financial CCM/CPO performance, referral patterns, and other metrics.
  • Discrete Time Tracking
    Robust “under the hood” time tracking architecture tracks all time spent on CCM/CPO in a fully compliant manner. Robust drill down/enhanced reporting is built in, should it be needed for an audit or other purposes.
  • Patient-Specific Resources
    Clinicians can send and post appropriate educational or community resources to groups of patients with specific chronic conditions.
  • Assisted Living and Nursing Facility Portals
    Chronic Care Management, LLC facilitates enhanced care and interaction between ALF and nursing residents, their families, and facility caregivers while providing nurses and caregivers a toolkit to electronically exchange documents, ask physician practices questions, provide patient updates, and utilize custom resources tailored to their care environment.
  • Home Health Portal
    Comprehensive functionality built to empower agencies in every interaction with referring physicians and clinician teams improves agency compliance, referral flow, and efficiency.