Chronic Care Management

Your practice provides a list of patients that could benefit from the program. Alternatively, our team can also help identify eligible patients and reach out to complete enrollment.

Our team of experienced care managers reaches out to patients, informs them that their primary care provider has referred them to the program, and obtains consent to finalize enrollment.

Our team works with your providers to design a care plan and set attainable goals for each patient. They make sure to perform qualifying activities to meet monthly time requirements and update goals.

 Chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, comprehensive care plan established, implemented, revised, or monitored; first 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month  

 Chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, comprehensive care plan established, implemented, revised, or monitored; each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month 

Note: Rates may vary by region. Average reimbursement for Southern California region, per MPFS Lookup.