Chronic Care Management Services

Are you looking for an alternative way to manage your chronic health conditions? Or perhaps a loved one’s health remotely?

If so, look no further than Compassionate Care Medical Professionals. Our chronic care management services are designed to support your health between office visits, help you follow your shared care plan, stay on track with your healthcare goals, manage your health more effectively, and save you money.

Through this care coordination program, you have someone in your corner 24/7/365, doing everything possible to make sure all your healthcare providers work as a team and share important information to improve your health.

Together, we will give you and everyone involved in your care peace of mind knowing you aren’t going without the information, appointments, treatments, or care you need. Call our chronic healthcare management doctors today at 888-316-9085 to discuss any questions or fill out the form on this page to request more information or schedule an appointment.

Care Focused on You

At Compassionate Care Medical Professionals, our chronic care management doctors provide our patients with with between-visit care that:

  • Connects you with clinical support 24/7/365
  • Focuses on you and your individual needs, values, and goals
  • Saves you time and money by helping you avoid duplicate tests, unnecessary treatments, and hospitalizations
  • Helps make doctor visits more productive by getting updated health information to your doctors prior to appointments
  • Helps you avoid complications, medical errors, trips to the emergency room, and problems with your medications
  • Motivates you to be more proactive about your health
  • Helps remove barriers to healthcare, such as cost concerns about medications or problems getting medical supplies or assistive devices

What to Expect Next

We’re here to ensure the chronic care management process goes as smoothly as possible. Below is a step-by-step process of what to expect when you sign up:

A Welcome Call

Your Care Liaison will give you a call soon to welcome you to chronic care management, and give you a brief overview of our services. During the welcome call, we’ll get to know you a little better and explain how our team will help coordinate your care under the direction of your Doctor, and in ways that meet your personal healthcare goals. We’ll also describe how we’ll gather your medical records, build your personalized care plan, and be there when you need us. If you can, please have a list of your current doctors and medications handy for the call.

Your Shared Care Plan

The care plan we create for you helps get everyone involved in your care on the same page. It will include the following information, which we will update on a regular basis: your health conditions, medications, doctor’s instructions, allergies, and medical appointments.

Regular Care Calls

Our practice wants your Care Liaison to check in with you regularly to see how you are doing and to make sure there isn’t anything you are going without, such as a medication refill, a referral to a specialist, etc. If there are days or times of the day that are better for you than others, just tell your Care Liaison.

We Are Here to Help

The most important thing to remember is we are here to help you. Our goal is to support you in achieving your healthcare goals, based on your priorities. If we can help you schedule doctor appointments, track down medical records, forward records to your next appointment, find resources that make your medications more affordable, or engage community resources on your behalf (such as transportation assistance to appointments, etc.), please let us know. If you are referred to other specialists, have visited the emergency room, or have been admitted to or discharged from the hospital, we will guide you through these transitions and request appointments or records on your behalf.

Frequently Asked Questions

Why do I need to be enrolled in the program?

Medicare and our practice believe that proactively managing a patient’s care all of the time, not just when they are in the doctor’s office, can improve patient health and decrease healthcare costs. In 2015, Medicare created an entire program – called Chronic Care Management – around this concept of 24/7 care coordination.

Provided to patients through their doctor’s care coordination program, chronic care management quickly proved successful in saving Medicare beneficiaries hundreds of dollars per year on average, improving their health, and reducing hospitalizations and emergency room visits.

Our practice is proud to provide you with important proven chronic care management services and “between-visit” care coordination that can help you get and stay as healthy as possible.

What are annual Medicare wellness visits?

The Annual Wellness Visit is a yearly appointment with your care provider to update your health records and ensure you are up-to-date on receiving preventive health care services (screenings and vaccinations).

Who is eligible?

All Medicare Part B members who have not had a Medicare AWV or “Welcome to Medicare” visit in the past 12 months.

How much does an annual wellness visit test cost?

Patients pay nothing out-of-pocket for this visit. However, during your visit if you require further tests or screenings, a co-payment or deductible expense may occur.

Is the annual wellness visit the same thing as a yearly physical?

No. An annual wellness visit is a yearly visit with your provider to create a personalized preventive health plan, whereas yearly physicals are for addressing chronic illnesses and performing routine lab work. However, your care provider may elect to perform additional services during an annual wellness visit which may have additional costs.

What should I do if I haven’t had an AWV in the past 12 months?

Call your clinic and ask to schedule your annual wellness visit. Talk to your provider about what you can do to prepare for the visit and what they would like you to bring.

What is covered as part of the annual wellness visit?

Below is a list of services covered in your annual wellness visit:

  • Update of your age, race, address, and contact information
  • Update of your medical and family history
  • Update of your list of current care providers
  • Measurement of blood pressure, height and weight
  • Screen for memory changes
  • Review of movement ability and risk of falling
  • Written preventive screening plan for the next 5 to 10 years

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