Services We Offer

Healthy foods and a blood glucose meter

DIABETES SELF-MANAGEMENT

African american couple outside exercising

DIABETES PREVENTION

Lady with Coffee

HYPERTENSION MANAGEMENT

remote monitoring

REMOTE MONITORING

Portrait of female African American doctor standing in her office

PROVIDER TRAINING

Description Of Services

DIABETES SELF-MANAGEMENT PROGRAM

Diabetes self-management education and support, a program accredited by the Association of Diabetes Care and Education Specialists, is provided by Sorgi certified diabetes educators to patients diagnosed with Type 2 diabetes.  The program consists of six group classes which support self-managemnt of the disease.  Individual action plans are developed to provide personalized and continued support and guidance throughout treatment.  Education topics include:  Healthy decision making, making healthy food choices, taking medications as prescribed, monitoring blood sugar, staying physically active, healthy coping and problem solving.

DIABETES PREVENTION PROGRAM

The Diabetes Prevention Program is designed to prevent or delay diabetes.  Twenty-five small group classes are facilitated by a Sorogi lifestyle coach who leads discussions of lifestyle changes that can alter behavior and result in improved health.  Diabetes Prevention Program activities include:  Personal goal setting, exercise, nutrition, and peer support.  Some topics covered include:  Eating healthy without giving up foods you love, adding physical activity even if you do not think you have time, dealing with stress, Coping with challenges, Getting back on track if you slip up, Staying motivated.  Benefits include improved health outcomes for patients, reduced health care costs, and improved quality of life.

HYPERTENSION MANAGEMENT

Self-monitoring of blood pressure combined with hypertension-related education and lifestyle changes that reduce stress can lead to improved clinical outcomes and prevent complications.  Our blood pressure program provides participants opportunities to join weekly education sessions, physical activities, cooking demonstrations, and work with a Registerd Dietitian to develop a customized nutrition plan to get the support they need to improve their overall health.

REMOTE MONITORING

Use of technology to monitor blood glucose levels or blood pressure readings in patients with diabetes or hypertension provides critical information on sugar levels, blood pressure, symptoms, diet,  medication adherence and effectiveness.  Regular monitoring by Sorogi staff can trigger appropriate interventions and prevent serious health complications.  RPM services includes patient training on use of technology, daily monitoring of results, reporting, alerts to patients and healthcare providers as needed with appropriate interventions, and patient support and information calls.

HEALTHCARE PROVIDER TRAINING
Chronic care managemnt training provided by Sorogi for healthcare providers helps equip them with evidence based skills to reat and care for patients with chronic disease conditions such as, diabetes and cardiovascular disease.  Training is geared toward clinical staff including physicians, medical assistants, nurses, and care coordinators.  For more information …
CHRONIC CARE MANAGEMENT

The Chronic Care Management Program (CCMP) assists healthcare providers to implement vaue-based patient care plans that are supported by the Centers for Medicaid Services (CMS).  Sorogi offers in-person and virtual care coordination services for patients with chronic health conditions.  Services include:  Patient outreach, developing patient-centered care plans, personalized care management and preventative care services, and medication management.

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Pilot Studies and Results

Sorogi pilot projects and studies have shown results in key ways:  

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    Average A1c of patients receiving diabetes education services dropped 1.7%
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    91% of patients receiving diabetes education services with repeat A1c showed improvement
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    Lowered A1c for African-American patients with uncontrolled diabetes following implementation of multiple interventions
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    Improved quality of healthcare and blood glucose testing with the use of a glucose monitoring system and by sharing of results with healthcare providers
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    Identified multiple patients with pre-diabetes using evidence-based screening tool in a primary care setting and enrolled them in diabetes prevention classes
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    Patients who received remote glucose monitoring had a 92% increase in engagement in care and no reported hospital or Emergency Department visits.