The goal of the ATLAS care coordination program is to provide guidance, counseling and education to patients, families and care facilities. ATLAS increases wellness while identifying and implementing care measures designed to decrease hospitalizations and crisis care by emphasizing prevention.

IHMG has a proven track record of success in identifying and implementing measures that significantly close HEDIS gaps, improve population health and increase CMS reimbursements.

Through ATLAS, IHMG’s team leads the following efforts:

• Identify patient populations in high risk categories.
• Conduct thorough health risk assessments and institute the management of disease and diagnosis-specific protocols aligned with HEDIS measures (labs, primary care visits, medication management, etc.).
• Initiate chronic disease management protocols.
• Develop comprehensive advance directives for all patients.
• Build enhanced relationships and trust with patients and families by focusing on education, counseling, personalized care and individual health goals.
• Assess and enhance the capabilities of the facility staff through hands-on training, allowing for earlier detection and effective interventions.

With IHMG’s ATLAS program, partners can expect:

• Timely completion and evaluation of recommended/required medical criteria (health maintenance such as labs, preventative diagnostics, immunizations, etc.).
• Appropriate implementation and maintenance of education measures and chronic disease management protocols.
• Completion of patient advance directives.
• Medication supply review for compliance and availability.

As a result, hospitalizations and emergency room visits are reduced, readmission rates are improved and perceptions regarding facility care is enhanced.