Chronic Care Management (CCM): 

A customized and innovative approach to managing the care of Medicare beneficiaries with two or more chronic conditions. Our care management is strengthened by remote communication between your scheduled doctor visits to actively oversee your health, thus decreasing hospital and emergency room visits. Our program ensures that the provider, care team, and family are all involved in the patient's care, working together from a cohesive, patient-centered care plan. We provide an extra layer of support, making sure your provider is informed when you need help and can track your progress in managing your conditions.

Principle Care Management (PCM):

A Medicare service tailored for patients with a single complex chronic condition. Similar to our Chronic Care Management, this service emphasizes care coordination, monitoring, and management to enhance patient outcomes, offering an additional layer of support to ensure that the provider, care team, and family are all actively involved in the patient's care to help avoid avid hospitalization or other unscheduled acute care.

Transitional Care Management (TCM):  

A specialized service ensures coordinated care for patients moving from inpatient to community settings, focusing on communication, medication management, follow-up appointments, and patient education to improve patient outcomes, reduce hospital readmissions and improve the overall quality of care delivery. Documentation of additional support from a healthcare provider or the practice's clinical staff is required. Transition of care requires that the patient be discharged from an inpatient setting to a community setting.

Remote Patient Monitoring (RPM):

Our proactive and efficient approach to enhancing your health involves utilizing digital technologies to monitor your vital signs remotely in real-time. These services encompass telehealth consultations and the deployment of various devices to actively oversee a treatment plan for chronic or acute conditions from the comfort of your residence, whether it's your own home or a care facility.