Learn more about Pro.

PRO

Learn more about PRIME Risk Stratification.

Risk Stratification

Learn more about the PRIME Group Dashboard

Group Dashboard

PHATE Population Health Mapping Tool

PHATE was commissioned by the ABFM and funded by the ABFM Foundation to help practices better understand and address the social risk factors in their patient population.

With the PHATE My Community tool, explore the social determinants of health that impact your patients. View the characteristics of your practice service area and drill down on specific social determinants, along with local resources to address them. Upload and geocode de-identified addresses to understand where subsets of your patient population live, see risk scores, and find local resources to address social deprivation factors.

With the PHATE Hotspotting tool, view clusters of diseases and poor outcomes within your patient population and the related social determinant information for those areas. Identify patients in high deprivation areas, and quickly find local resources for referral or community collaboration to address social needs.

More about PHATE

CareGap

Examine each patient’s care quality gaps at the patient or measure level and see Social Deprivation Index data from PHATE for insight into patient’s community characteristics and potential social deprivation risk. Live web links to local resources in the patient’s neighborhood to address their needs are shown on screen along with the patient’s care gaps.

PRIME PRO Dashboard

Patient Reported Outcomes (PRO) Platform

Commissioned by the ABFM and funded by the ABFM Foundation, the PRO Platform fields PRO surveys and presents collected data in an easy to access, analyze and act on graphical format. This tool also allows the user to review and compare practice level, location level and clinician level scores on individual PRO survey questions, receive alerts for actions needed, and send survey reminders to patients with unsubmitted surveys.

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Patient Empanelment

Originally designed to meet Comprehensive Primary Care Plus requirements, this tool allows you to empanel patients with a specific clinician and care team, and use these panels for Risk Stratification. Care teams may be changed and patients and clinicians assigned and unassigned as well.

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Risk Stratification

Select an empaneled patient, then enter social data and risk factors to calculate a risk score based on the Charleson Comorbidity Index, or use Clinician Intuition scoring, to calculate a patient’s risk score. Upload, manage and update care plans.

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Group Dashboard

An excellent resource for larger health organizations, groups like Accountable Care Organizations (ACOs) and Clinically Integrated Networks (CINs), the Group Dashboard allows users to view and manage quality data within user-defined groups, at the practice, location or clinician level.

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Reports Module

Access and run several standard reports for use in ongoing Quality Improvement projects, for internal reporting purposes, working with payers, and practice management