Well Living Initiative

  • Home
  • /
  • Well Living Initiative

enhance the Human Connection With Patients & Improve Care Plan Adherence

of Adverse Outcomes 
Involve Social Determinants of Health

Eighty percent (80%) of adverse patient health outcomes involve factors (social, economic, and behavioral) outside the traditional healthcare delivery system. Improve care quality by extending your practice beyond its walls without increasing your workload.

What Is The Well Living Initiative?

The Well Living Initiative is a suite of patient services and technologies that elevate patient care, quality measures, reduce staff workload, and increase your bottom line.

Providers are under increased pressure to improve patient health and outcomes. However, the sheer complexity of influencing patient behavior through a high-touch engagement model that prioritizes initiative-taking wellness has made it difficult to swallow the market’s shift from Fee-for-Service to Value-Based care. The Well Living Initiative is an opportunity for Providers to improve patient outcomes, care quality, care satisfaction, population health and revenue by closing gaps in care and simplifying the patient engagement process through:

Annual WellNess Visits

Annual Wellness Visits (AWV) are the keystone for gathering critical patient risk data to calculate each patient’s overall risk scores annually. Introduced in 2011 by CMS to help improve longitudinal care outcomes, only 32% of patients are participating, primarily because the outreach required to build momentum is more than an already-stretched-thin Provider can manage. The Well Living Initiative team simplifies the process, collaborating directly with patients to collect their information and easily coordinate scheduling.

Chronic Care Management

Chronic Care Management (CCM) is a critical component of patient care that contributes to better patient outcomes and higher satisfaction. The Centers for Medicare & Medicaid Services (CMS) recognizes CCM takes time and effort. CMS established separate payment under billing codes for the additional time and resources you spend to provide the between-appointment help many of your Medicare patients need to stay on track with their treatment plans for better health.

Nurse Triage and Admin Support

With staff shortages reaching record levels in clinics and hospitals, the ability to respond timely to patients and other providers is critical to improving patient outcomes and satisfaction. The Well Living Initiative team of nurses and administrative staff take the stress from incoming calls for patient appointments and nurse triage services. 

The Well Living Initiative Telephone Triage staff assures that communication with each caller will be handled professionally and tactfully. The team will manage patient calls to the office and determine their need or the urgency of the medical issue, the level of provider who should respond, the appropriate location for the patient to be seen (if necessary), and the timing of appointment scheduling. When applicable, the caller's symptoms will be assessed and triaged using your nursing process and approved guidelines to obtain the appropriate level of care and/or self-care advice.

Transitional Care Management

Every year, nearly 1 in 5 Medicare patients is readmitted to the hospital within 30-days of discharge. Unfortunately, over half of those did not have contact with their primary care provider after discharge, equating to 2.6 million seniors and costing the U.S. healthcare system over $26 billion

The Well living Initiative team addresses the problem with Transitional Care Management (TCM). TCM is a post-discharge service designed to provide Physician-led, coordinated care to patients following an inpatient discharge to help reduce readmissions, improve health outcomes, and secure savings. With TCM, clients see a dramatic reduction in readmissions, with some moving from an average of 9% to just 2%!

Remote Patient Monitoring

The Well Living Initiative team reaches out to patients monthly to make sure that they are staying on track with their care plan and assisting with care coordination, and their social and economic needs. Remote patient monitoring provides a reimbursable way for Providers to monitor acute and chronic conditions to ensure any worsening or troubling symptoms are caught and addressed proactively.

In aggregate, the Well Living Initiative suite of services improves care coordination, supports better care plan compliance, and minimizes the stress and financial strain associated with socioeconomic determinants of health. You realize increased profitability, higher MIPS, MACRA, and Value-based scores, improve patient connectivity and availability, and fundamentally see better overall outcomes, all without hiring additional staff or the administrative tools you would need to coordinate such a comprehensive patient engagement strategy internally.

Well Living Initiative Benefits

Partnering with the Well Living Initiative team becomes an extension of your clinic, closing gaps in care, and enhancing patient connectivity. In addition it increases revenues without increasing workload for the Provider or staff.


Patients report increased satisfaction with the care they are receiving because they get additional supports aiding in care plan compliance.

Improves Scores

Enables higher MIPS, MACRA, and Value-Based Care scores. Enhances CHAPS scores.

Addresses Staff Shortages

Reduces or eliminates the need for additional staff. Medical staff can focus on supporting the Provider with face-to-face patients.


Our smart technology uncovers gaps in care within minutes to create accurate RAF and HCC scores. Data analytics along with a AWV improves profitability and streamlines workflow.

How It Works

The Well Living Initiative integrates seamlessly with your team to offer clinic-based customized services.

Phone Call Rerouting

Well Living Initiative's medical personnel answer all incoming phone calls to your practice.

We Immediately Triage Incoming Patient Calls

Here's what your practice can expect: 

  • Immediate response to patient inquiries from our qualified nursing team.
  • Patients scheduled based upon your scheduling criteria.
  • Assistance with patient referrals to or from specialty groups.
  • Assistance with medical record requests.

Improve Quality Care and Reduce Staff Stress Levels

Here's what your practice can expect: 

  • In-house staff is able to concentrate on face-to-face patient interaction.
  • Improved patient outcomes because physicians have additional patient information and patients have support for their care plans.
  • Improved communication.
  • Increased revenues without increased workloads for the Provider or staff.

What Are You Waiting For? Make a real change Now!