The combination of type 2 diabetes and chronic kidney disease markedly increases mortality, and there is a high rate of co-occurring heart failure.
Avoidable re-admissions, disease-progression and cardio-renal complications increases costs dramatically.
GDMT (Guideline Directed Medical Therapy) for conditions like heart failure and chronic kidney disease are well established, but very poorly implemented.
Patients struggle to find individual experts to manage each disease domain let alone anyone who can take an integrated approach to multiple complex conditions.
SDOH must be assessed to correctly estimate risk and addressed to reduce it.
Our fully systematized technology platform seamlessly incorporates every detail about the patient into each decision across diagnosis and management. Through this platform we manage guideline-directed medical therapy in kidney and cardiac conditions as well as type 2 diabetes and obesity.
Onboarding is rapid and Atman’s platform and the care team fully integrates remote care to create a personal trajectory that ensures the right care is delivered at the right time in the right place.
Our care navigators, who work closely with the physician on the same software platform, are attentive and empathic guides who help the patients to attain their individually tailored goals.
The Atman platform ensures that the latest evidence shapes every decision, no detail is missed, and maximizes the impact of emerging technologies on outcomes. Further, using AI, we continuously improve our patient engagement capabilities and are deploying automated call agents for medication reconciliation, reminders and follow ups.
We partner with providers and payers as a remote service provider or technology vendor to manage select disease conditions in targeted patient populations.
We work with our partners to screen and enroll patients into our remote management programs
Once enrolled, we engage with the patients directly and conduct initial program setup, including appropriate devices provisioning and data intake
After collection of all the information, our platform helps determine patient specific goals for given conditions
Next, we identify personalized treatment plans considering all patient specific information, including currently administered medications, known co-morbidities and preferences
Our remote team then works with the patients to determine optimal medications and titrations by rapid monitoring of drug response
Once optimal goals are reached our team will continue to engage with the patients and monitor/optimize deviations from the goals
We work with our Partners to form and train their remote management team in patient identification and disease management as supported by the platform
This remote team then uses Atman platform in conjunction with the local EMR to manage the patients as per remote management workflow driven by the Atman Platform.