For Chronic Care & Population Health Teams

Deliver the Between-Visit Care Your CCM Reimbursement Already Covers

Medicare pays for chronic care management time, but only if it's documented, delivered consistently, and actually reaches your highest-risk patients. Avidon gives your team caseload tracking, automated check-ins, and outcome reporting built for exactly that work, at population scale.

Avidon coaching software reporting dashboard showing engagement and outcomes data
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Patient adherence rates
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Reduction in program costs
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Less admin time per care team
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Evidence-based courses

The Challenge for Chronic Care & Population Health Teams

CCM and population-health programs come with budget already attached, Medicare reimburses non-face-to-face care management time. But capturing that reimbursement means proving the work happened: logged time, documented outreach, and outcomes tied back to each patient. Most teams end up doing this in spreadsheets, sticky notes, or a CRM never built for clinical caseloads, which caps how many patients a care team can actually manage well.

Avidon gives your team the caseload infrastructure to run CCM and population-health programs at the scale your reimbursement model was designed to support, without adding headcount to keep up with documentation.

What Chronic Care Teams Get with Avidon

Built for between-visit management, not adapted from a sales CRM or bolted onto an EHR.

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Time-Tracked Care Management

Log non-face-to-face care time automatically as coaches complete check-ins, calls, and outreach, exactly the documentation CCM billing codes require, without a separate spreadsheet.

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Standards-Based Integration

Connect Avidon to your existing systems via REST API, webhooks, SFTP, and SSO. Eligibility files, risk-stratification data, and reporting integrations keep your workflows unified.

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HIPAA & SOC 2 Compliant

HIPAA-compliant messaging, encrypted data at rest and in transit, BAA included. ISO 27001 and SOC 2 certified, GDPR compliant. Built to pass IT security review without months of back-and-forth.

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Outcomes Reporting for Leadership

Demonstrate program impact with engagement metrics, health outcomes data, and utilization reports leadership can hold up against reimbursement targets. Full reporting APIs for every event.

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Caseload Management Dashboard

Real-time visibility into every patient in the program. Stratify by risk, assign coaching pathways, and ensure no one falls through the cracks between visits.

50% Less Admin Time

Automate scheduling, reminders, task handoffs, and check-ins. Your care team spends more time on outreach that counts, and less time chasing documentation.

Clinical Integration & Compliance

Avidon meets the security, interoperability, and regulatory standards required before any technology touches patient data or billing documentation.

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HIPAA & SOC 2 Compliant

End-to-end encryption for all protected health information. Annual SOC 2 Type II audits, BAA provided for every client, and ISO 27001 certified infrastructure.

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EMR & EHR Integration

Connect Avidon to Epic, Cerner, or any EHR via HL7 FHIR, REST API, or SFTP. Risk-stratification and referral data flow in, care management outcomes flow back.

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SSO & Identity Management

SAML 2.0 and OAuth single sign-on integrates with your existing identity provider. Care teams authenticate through your system, not a separate login.

How Chronic Care Teams Use Avidon

From CCM billing documentation to diabetes prevention, Avidon adapts to the between-visit programs your team already runs.

01 · CCM

Chronic Care Management

Document reimbursable non-face-to-face care time automatically as it happens. Structured check-ins and outreach logs give your billing team exactly what CCM codes require, with no extra paperwork.

02 · Prevention

Diabetes Prevention Program (DPP)

Deploy a CDC-aligned curriculum with built-in session tracking, participant milestones, and completion reporting, structured for DPP recognition requirements from day one.

03 · Population Health

Population Health Management

Stratify your population by risk level, assign targeted coaching pathways, and track engagement and outcomes across every patient, not just the ones who show up.

Proven Outcomes for Chronic Care Programs

Real results from care teams managing chronic conditions at scale on Avidon.

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Increase in Protocol Compliance

A health system more than doubled patient adherence rates for multi-stage nutritional protocols using Avidon's enhanced coaching model.

Read the case study →
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Reduction in Program Costs

An insurance services company streamlined operations and automated administrative processes, cutting program expenses by 30% while boosting participation by 67%.

Read the case study →
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Course Completion Rate

Across thousands of participants in outcome studies, Avidon-powered programs achieved a 91% course completion rate.

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See how Avidon supports your CCM and population-health programs.

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Common Questions

Yes. Avidon automatically logs non-face-to-face care time as coaches complete check-ins, calls, and outreach, giving your billing team the documentation CCM reimbursement codes require without a separate tracking system.
Yes. Avidon supports structured, CDC-aligned curriculum delivery with session tracking, participant milestones, and completion reporting built for DPP recognition requirements.
Yes. Avidon connects to Epic, Cerner, or any EHR via HL7 FHIR, REST API, or SFTP. Risk-stratification and referral data flow in, and care management outcomes flow back automatically.
Avidon is HIPAA-compliant, ISO 27001 certified, and SOC 2 Type II audited annually, with a BAA provided for every client. Most security reviews clear without extended back-and-forth.
It depends on program design and risk mix, but teams typically see meaningful caseload increases once manual tracking and documentation are automated. We'll model expected capacity for your specific program during a call.
Yes. Most chronic care and population-health teams start with a single program, CCM or DPP are common starting points, before expanding to additional conditions or populations.

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