Care Management

Care Management is an important service from Medicare for patients living with one or more chronic conditions. Care Management extends care into the home, outside of the regular provider visit. The service provides home visits, 24/7 access to a care team, and a dedicated nurse that will get to know you and help you manage your health care.

Our Care Management team includes medical providers (NP, PA), nurses, pharmacists and other health professionals. This extended support team coordinates your care, manages your health conditions, communicates with specialists and caregivers, and stays in touch with you between visits from your medical provider.

A provider will explain the Care Management program during your visit and can help you enroll. While you can opt out at any time, enrollment in this program is required to receive care at our practice as we believe it is an essential part of managing complex health needs.

• Home visits from medical providers
• Access to 24/7 support
• Dedicated nurse care concierge
• Comprehensive care plan updated as your health needs change
• Assistance with keeping track of referrals, preventative screenings, and other orders placed by PCP or care team.
• Pharmacy consultant to manage medications
• Blood draws from the comfort of your home
• Transitional care team to help with smooth hospital transitions

If you are a Qualified Medicare Beneficiary, Medicare/Medicaid dual-eligible, or have secondary insurance, you likely will NOT have a copayment. Otherwise, there will be a monthly copay for Care Management. Copays vary depending on monthly engagement and your insurance coverage (averaging $10-40/month).

Care Management services are billed monthly, not per visit and are determined by the type of care completed for the month, including Chronic Care Management (CCM), Principal Care Management (PCM) and Advanced Primary Care Management (APCM) services.