Chronic Care Management (CCM)

Patient: Regular CCM means you can better manage your care and spend more time focusing on your health. CCM can help you work toward your health and quality of life goals. Better care management can help you avoid health events such as trips to the emergency department or worsening health.

Provider: Patients will gain a team of dedicated health professionals who can help them plan for better health and stay on track for good health. Services such as monthly check-ins and ready access to their care team, improve patient care coordination, including improved communication and management of care transitions, referrals and follow ups.

Patients will receive a comprehensive care plan. The plan will help support disease control and health, management goals, including physical, mental, cognitive, psychosocial, functional, and environmental factors. Patients may also receive a list of suggested resources and community services. Additionally, patients may be encouraged to keep track of referrals, community support, and educational information. Care plans can also help caregivers who are furnishing unpaid care.

Encouraging patients to use CCM will give them the support they need between visits. Having a regular touch point ma help patients think about their health more and engage in their treatment plan, for example, by becoming more conscious of taking medications, managing fall risk, and other self management tasks. Getting this help may also encourage patients to stay on track and improve adherence to their treatment plan.

Ask our staff if you qualify for CCM.