CHRONIC CARE MANAGEMENT
Medical HouseCalls
Developing Programs for Comprehensive Care
Between doctor visits, managing medications, and following advice from different health care professionals, managing chronic conditions can be confusing and overwhelming. Supportive HealthCare's Chronic Care Management program provides patients with an ongoing care pathway for complex chronic health problems. Chronic Care Management provides non-face-to-face care coordination services, including communication with other treating health professionals, medication management, and plan of care maintenance. Every Chronic Care Management patient will be matched with their own CCM nurse who will communicate with the primary care provider and coordinate with specialty healthcare providers, labs, testing facilities, and caregivers. Your Chronic Care Management Nurse will call every month, allowing early detection of any medical changes for immediate intervention to prevent unplanned hospitalization and disruption of care in the home.
Chronic Care Management Services
- Minimum of 20 minutes a month of CCM services
- Personalized assistance from a dedicated CCM Nurse
- Coordination of care between your specialists, pharmacy, testing centers, hospitals, and more
- Clinical support is available by phone 24/7
Qualifying Factors
- Patients must have two or more chronic conditions to qualify
- Functional decline
- Exacerbation or decompensation