Monogram Health

Monogram Health is a multi-specialty provider of in-home, evidence-based care for people living with multiple chronic conditions. The company operates as a value-based care organisation, delivering a comprehensive, personalised and whole-person approach to treatment in patients' own homes, with the stated aim of improving outcomes while reducing healthcare costs.

Care is delivered by an interdisciplinary team that includes doctors, nurse practitioners, nurses, specialists, dietitians, pharmacists and social workers. Services are available 24 hours a day, seven days a week, including holidays. Clinical work spans the management of conditions such as diabetes, hypertension, chronic kidney disease, heart failure, COPD, depression and other metabolic disorders, alongside medication review, prescribing and patient counselling.

Beyond clinical treatment, the model extends to palliative care, behavioural health support, care coordination and patient education, as well as practical assistance with social needs including food access and healthy meal plans, housing, transportation and financial assistance. Technical domains covered by the organisation include in-home chronic disease management, value-based care delivery, medication management and prescribing, and support for the social determinants of health.

Monogram Health describes its care delivery as proactive and personalised, organised around a team-based model in which multiple disciplines contribute to each patient's treatment plan. Further details on the company and its work are available at monogramhealth.com.