Chronic care management is a specific care management service that provides coverage for patients with two or more chronic conditions for a continuous relationship with their care team. This includes formulating a comprehensive care plan, interactive remote communication and management (usually over the phone), medication management, and coordination of care between providers.
Chronic care management is beneficial for patients in terms of ongoing health and wellness support, increased access to appropriate medical resources, enhanced communication with members of their care team, reduction in emergency room visits and hospitalization or readmissions, and increased engagement in their own healthcare.
In-Home Care As Needed
Interdiciplinary Care Team
Remote Montioring & Virual Visits
Health Coaching
Care Coordination
Outcomes & Reporting
In-Person Assessments
Who is eligible for CCM?
All patients who have two or more qualifying chronic health conditions that are expected to last 12 months and the conditions put them at risk of flare or decline are eligible for CCM services.
