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Integrating an advanced clinical model with population health and patient engagement

Dramatic results

Instant and long-term patient behavior changes and improved health, while providing improved clinical outcomes that deliver significant health care savings — immediately and over time.

Our unique approach begins with Vigilant Health’s proprietary advanced care model led by our care team working in collaboration with local physicians.

We focus on highly personalized patient engagement and outreach, supported by the Company’s clinical model, training programs, and population health analytics and technology.

Vigilant Health equips each team member with innovative tools and support designed to strengthen the patient relationship and the team’s collaboration with community physicians.

Advanced Care Model

• Physician-Led Care Team
• Local Physician Collaboration
• Data-Infused Clinical Model
• Flexible Care Delivery

Patient Engagement

• NP Navigators
• Chronic Disease Expertise
• Patient Empowerment
• Individual Plans of Care

Population Health

• Proprietary Technology
• Data Integration
• Risk Stratification
• High Performance Network

Advanced Care Model

Physician-Led Care Team

Our care team of health care professionals works side-by-side with our physician partners. The clinical model is designed to provide constant training and continual education while achieving high standards of diagnostic quality and medical management. The results are superior clinical outcomes and substantial cost-savings.

Local Physician Collaboration

We partner with local physicians to provide clinical leadership, insure high standards of medical management, and manage those patients who require more attention and support – a level of care that the current volume-based health care environment typically discourages. Our strong collaboration is with local primary care physicians.

Data-Infused Clinical Model

Vigilant Health’s proprietary technology translates claims and clinical data into a clinical model that effectively allocates and targets health care resources, including the identification and prioritization of at-risk patients. The model enables the Nurse Practitioner (NP) Navigator, supported by the care team, to conduct patient outreach and match the right care to the right patient at the right time.

Flexible Care Delivery

Because the needs and circumstances of each client we serve are different, Vigilant Health offers a variety of options for the delivery of care, including on-site clinics, near-site clinics, specialty care, working with local physicians in their offices, and delivering care through virtual media.

Patient Engagement

NP Navigators

The Nurse Practitioner (NP) Navigator manages patient outreach and communications with local physicians and other provider partners as well as the Vigilant High Performance Network. The NP Navigators provide coordination and care, supporting the delivery of appropriate, high quality care.

Chronic Disease Expertise

Our proprietary technology gives physicians and care teams actionable information as part of each visit, enabling a comprehensive understanding of the patient’s health. Each encounter includes reviewing existing health issues and emerging risks of chronic diseases, acting on each patient’s needs, and implementing a custom plan of care.

Patient Empowerment

All members of the care team, including our diabetes educators, health coaches, and dieticians, are involved in developing each patient’s plan of care, supporting the patient to embrace his or her plan and any needed lifestyle changes. Vigilant Health engages with patients to deliver personalized information and targeted education as a part of each face-to-face encounter as well as through virtual visits and self-management tools.

Individual Plans of Care

We go beyond the typical clinical care plan and translate highly personal plans of care developed by physicians and the care team into actionable steps and events. The care team uses these plans to support each patient throughout his or her journey to optimal health. Each provider has a universal medical history for each patient at each visit derived from the plan of care and comprehensive claims data.


Population Health

Proprietary Technology

Our technology produces a detailed plan of care for the entire health plan or population and each member, as well as creating a universal medical record. It also combines medical analysis and sophisticated clinical interpretation to deliver actionable information and decision-making tools for each patient at each visit. We measure and report financial and clinical results monthly, quarterly, and annually, and identify financial and clinical trends.

Data Integration

We aggregate all available patient data from multiple years, including claims, pharmacy, EHR, health assessments, and screening data, into a single database. We translate the data into actionable information that is used by our entire care team, including our community partners.

Risk Stratification

Needs and gaps in care are identified at both the individual patient level and plan group level and presented to the clinical team as a risk stratified view of the total population. NP Navigators and the care team use this data daily to prioritize patient outreach and communication — identifying patients at highest risk.

High Performance Network

We use data and our patients’ experiences to identify physicians and other providers in a market who are delivering the highest quality of care. The NP Navigator uses the claims data, outcomes, and relationship data along with plan design to facilitate and assist the patient to become a better consumer of health care at a lower cost. In turn, each patient has an advocate to navigate the complex health care system.

Let us design an advanced care model for your population that will dramatically improve health and reduce costs.

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