Providers and Hospitals

Chronic Disease Management

Individuals with multiple chronic conditions account for a disproportionate share of health care costs, one aspect of which is the number of annual hospital admissions and readmissions. According to the Agency for Healthcare Research and Quality (AHRQ), “One study showed that nearly 20 percent of Medicare patients discharged from hospitals were readmitted within 30 days for an exacerbation of the diagnosed condition. Nearly one-half of the readmitted patients had no post-discharge contact with health care professionals. Chronic disease management can reduce hospital readmissions and lower health care costs.”

6 in 10 adults have a chronic disease, 4 in 10 adults have two or more, and the number of individuals living with chronic health conditions continues to rise.

The answer, again according to the AHRQ is “to identify high users of health care services, design individualized care management plans, and monitor each patient's progress and compliance with treatment … Intensive post-discharge planning and counseling are effective interventions.”

6 in 10
Adults have a chronic disease
4 in 10
Adults have two or more

The innovative Wellbridge Health chronic disease management program incorporates over 400 annual touchpoints into its care management model with 7-day/week remote symptom monitoring via simple smartphone app (<2 minutes/day) and weekly, face-to-face health coaching via HIPAA-compliant video chats with a dedicated master’s-level health coach.

This approach ensures timely symptom response, as well as an opportunity to address the social determinants of health. Our proven protocol focuses on reducing avoidable ER visits and hospitalization through behavior change, focused and individualized chronic disease management education, attention to compliance with treatment plan and follow-up care, guidance on seeking the “right care at the right time,” medication management, and assistance overcoming barriers to optimal self-care. All of our health coaches have additional training in behavior change theory and techniques.

Pricing and Guarantees:

  • Please contact us for pricing for your specific organization.
1. Individualized Plan
  • Health and Wellness Assessment
  • Psychosocial Assessment
  • Medication Assessment
  • PHQ 2-9
2. Remote Monitoring
  • Chronic Disease Symptoms
  • Medication Side-Effects
  • Depression Symptoms
  • Enhanced Engagement
3. Behavior Change
  • Nutrition
  • Physical Activity
  • Stress Management
  • Treatement Adherence
4. Self Management
  • Immunizations
  • Preventative Care
  • Medication Adherence
  • Plan of Care Involvement

The innovative Wellbridge Health chronic disease management program incorporates over 400 annual touchpoints into its care management model with 7-day/week remote symptom monitoring via simple smartphone app (<2 minutes/day) and weekly, face-to-face health coaching via HIPAA-compliant video chats with a dedicated master’s-level health coach.

This approach ensures timely symptom response, as well as an opportunity to address the social determinants of health. Our proven protocol focuses on reducing avoidable ER visits and hospitalization through behavior change, focused and individualized chronic disease management education, attention to compliance with treatment plan and follow-up care, guidance on seeking the “right care at the right time,” medication management, and assistance overcoming barriers to optimal self-care. All of our health coaches have additional training in behavior change theory and techniques.

Pricing and Guarantees:

  • Please contact us for pricing for your specific organization.
Interested or have questions?
Talk with us.

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