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2. Chronic Care Models
and Goals
An essential component of a
healthcare system that promotes
high-quality chronic disease care is
the Chronic Care Model (CCM).
Chronic disease management goals
are to minimize symptoms, improve
quality of life and prevent
unnecessary hospitalizations.
3. Chronic Diseases and
Conditions:
• Alzheimer's Disease And Related Dementia
• Arthritis (Osteoarthritis And Rheumatoid)
• Asthma
• Atrial Fibrillation
• Autism Spectrum Disorders
• Cancer
• Cardiovascular Disease
• Chronic Obstructive Pulmonary Disease
(Copd)
• Depression
• Diabetes
• Hypertension
• Infectious Diseases Such As Hiv/aids
• Substance Use Disorders
4. Benefits
Our CCM program helps you ease your
frustration and streamline the
coordination process by coordinating with
your entire care team through your
dedicated CCM system, including your
primary physician, condition specialists,
mental health team, surgeons, and even
social workers. By removing the stress and
pressure of care from your shoulders, we
help you focus on your health and your
needs.
Coordinated care across teams
5. CCM + Patient Portal can give you one
health provider with full knowledge of
your health history and a clear picture
of your overall health. You can rest
easy knowing they'll cover everything
essential to your health. They won't
miss anything, which means you're
getting better overall and preventive
care for your chronic condition.
Improved overall care
6. Chronic health conditions do not follow
regular business hours. When an urgent
health issue arises, you can always reach a
healthcare professional with CCM. We may
refer you to a specialist or have you speak
with one of our qualified providers based
on your health condition. However, you're
never alone.
24/7 access to providers
7. As soon as you enroll in our chronic
care management app, you won't
have to remember to update your
team. You will have 1-2 phone calls
with your CCM provider every month.
Your provider can address any
concerns and coordinate your care
team to ensure everyone is up-to-date
with your health. These check-ins
allow you to report any changes in
your health, health care plan, or
lifestyle.
Regular phone check-ins
8. Patients with lower
CCM software
their annual healthcare expenses for
several reasons, including:
Financially beneficial
• Reduction in an unnecessary
hospital or emergency room visits
• Ability to ask questions to a
qualified provider over the phone
• Help to find less-expensive
medication and treatment options
• Achieving healthcare goals reduces
dependence on expensive
therapies