• Innovation in Action

Jan 19, 2024

What is a Chronic Health Condition, and How Can My Doctor Help?

Black woman, doctor and senior patient with tablet, results and listen for health planning, advice or cancer. African medic, mobile touchscreen and healthcare with trust, tech and support in hospital

A chronic health condition is a disease that lasts more than a year and requires ongoing medical attention.

The Centers for Disease Control and Prevention (CDC) lists some of the examples below as chronic conditions. These examples are not inclusive though.

Image source: Chronic Diseases in America | CDC

What is Medicare Chronic Care Management (CCM)?

If you have two or more health problems that will last for at least a year, and these problems could make you very sick or make it hard for you to do things, you might need extra help.  Chronic Care Management is a service that can help you with this. If you have Medicare Part B, your doctor, and a special team may be able to help you handle your health problems and make your life better.

Many chronic conditions can be managed with medications, a healthier diet, and behavior changes like reducing tobacco and alcohol use. Your care team can help you with these based on what you want or need.

What Does CCM Include?

CCM is like having a special team to help you stay healthy. You are at the center of this team. This team will work with you, your doctor, pharmacist, and your other medical providers to create a personalized care plan to help you reach your health goals.

It includes an initial face-to-face visit with a physician, nurse practitioner or physician assistant. Your doctor will still see you for your regular office visits, but the good thing is that your team can also help you take care of your health even when you are not seeing your doctor every month.

If you have a chronic condition, your team can help coordinate your care, such as phone check-ins and access to your electronic patient portal. They can ensure your refills are done on time and that you understand the best way to take your medications. You can also contact them if you need help, day or night.

Your team can also help you learn how to manage your conditions and provide helpful guidance and resources. In addition, they can refer you to other providers and specialists if needed.

Also, if you ever need to go to the hospital or into a nursing facility, they can help coordinate your care.

What Do I Need to Do?

CCM can help you maintain your health, avoid hospitalization and save money. If you are interested in learning more about CCM, you can ask your primary care physician if they offer this service.

It is important to note that you will need to give your doctor permission to enroll you in the CCM program, and you can stop at any time. Additionally, please keep in mind that only one doctor can provide you with CCM services at a time. For instance, if you have a primary care physician and a cardiologist, only one can provide CCM services.

A small monthly fee may apply to receive CCM services, but if you have other insurance like Medicaid, it could cover the remaining cost. These costs can vary depending on where you live and other co-insurance you have. Talk to your doctor about potential costs.

If your doctor does not provide CCM Services, ask them to reach out to us by contacting Jim Bugg, Health Quality Innovators Consulting Manager, at jbugg@hqi.solutions. We can give them the help and assistance they need.

Watch this video to learn more about Chronic Care Management services to see if is right for you.


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