The upstream layer your care coordinators have been asking for.
Social isolation carries the mortality risk of smoking 15 cigarettes a day. Elitesgen gives health systems an HIPAA-aligned wellbeing and connection layer that supports social prescribing, CCM programs, and community-based care coordination.
Billing codes illustrative. Scope confirmed during clinical diligence.
Discharge instructions do not reach the living room. SDoH data does not reach the care plan.
Population health teams are being held accountable for outcomes the EHR does not measure. Here is where the gap usually shows up.
- 01
Patients readmitting because discharge doesn't reach their living room.
- 02
Care coordinators referring to community resources that no longer exist.
- 03
Value-based contracts that pay for outcomes the EHR can't measure.
- 04
Social determinants data that sits in a spreadsheet, not a workflow.
Social prescribing, CCM fit, and SDoH signals that flow into the care plan, not into a PDF.
Three capabilities a care coordinator can actually use. Clinician-initiated, patient-directed, documented for billing.
Social prescribing
Clinician-initiated, patient-directed
Prescribe connection the way you prescribe a statin. Patients consent, participate, and come back with signals you can route.
CCM and RPM fit
Billable-workflow integration
Documentation that supports chronic care management coding. Clinical-grade audit trail.
SDoH signals
Operationalized, not reported
Loneliness, isolation, and belonging signals that flow into your care-plan templates, not into a PDF.
IDNs, ACOs, FQHCs, and behavioral health providers.
Complement to, not replacement of, clinical care. Enterprise SSO and DPA. BAA included on Enterprise. Foundation-subsidized pricing for mission-aligned safety-net organizations.
IDNs and multi-hospital systems
Enterprise SSO, enterprise DPA
ACOs and value-based care
Outcome attribution at the panel level
FQHCs and community health
Foundation-subsidized pricing available
Behavioral health providers
Complement to, not replacement of, clinical care
Epic (FHIR R4) · Cerner · Athenahealth · Custom FHIR endpoint
Documented for billing. Disclosed for audit. Published for peers.
Our social prescribing methodology is published. CCM documentation templates are open to review before you sign. We share the measures, the limits, and the reference implementations we have tested.
Elitesgen, Inc. is wholly owned by Elites Generation Foundation, a 501(c)(3) whose charter legally forbids behavioral advertising and the sale of individual user data.
Align with your population health strategy.
A scoped conversation about your panel, your billing model, and where social prescribing fits your care pathways.