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What is Chronic Care Management

Chronic care management is any medical care that is provided to patients with chronic conditions and diseases by doctors. Chronic means that a condition or disease lasts more than a year, is persistent, and requires continuous medical attention. This includes mental and physical conditions such as depression, diabetes, or other medical conditions.

Chronic disease management in Charlotte refers to chronic care services that are provided to Medicare beneficiaries who have more than one chronic condition. These services include in-person, face-to-face visits as well as communication and coordination of care for chronic conditions.

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A comprehensive care plan is required for chronic care management. It includes:

  • A record of chronic conditions for the patient
  • Personal information
  • Goals
  • Providers of health care
  • Medications
  • Any other services needed to manage their condition.

A comprehensive care plan is a document that outlines to patients the details and coordinates their care. Medicare recently expanded its coverage to include CCM for patients with two or more chronic conditions expected to last at most one year.

Understanding Chronic Care Management

Chronic care management programs are available to patients who have at least two chronic conditions. These include, but are not limited to, Alzheimer's, dementia, arthritis, and asthma, as well as multiple sclerosis, multiple sclerosis (lupus), high blood pressure, hypertension, and infectious diseases.

Chronic care management is a service that provides services beyond face-to-face visits. A comprehensive electronic health record is one of the most important features. This includes information about the patient's medical history, medications, allergies, past care providers, demographics, as well as their conditions. Patients with chronic conditions often see multiple providers. An electronic record is crucial to ensure that the patient receives optimal care.