Services
National Chronic Care Management offers a robust Chronic Care Management service designed to support patients with one or more chronic conditions. Our team coordinates comprehensive care by providing personalized care plans, regular check-ins, medication management, and education to empower patients in managing their health. By focusing on proactive engagement and continuous communication, we aim to reduce hospitalizations and improve the overall quality of life for individuals grappling with chronic illnesses.
Benefits for Patients:
- Improved health outcomes and reduced complications from chronic conditions.
- Enhanced access to healthcare resources and education about their conditions.
- Regular communication and support, fostering a sense of connection.
- Personalized care plans that address individual health goals.
Benefits for Providers:
- Streamlined care coordination, reducing the burden on healthcare staff.
- Decreased hospital readmission rates and improved patient retention.
- Better insights into patient health through regular monitoring.
- Increased patient satisfaction and engagement.
Chronic Care Management
Remote Patient Monitoring
With the advancement of technology, our Remote Patient Monitoring service enables healthcare providers to track patients’ vital signs and health metrics from the comfort of their homes. Using approved devices, we collect real-time data on the patients’ conditions, which allows for timely interventions and alerts if there are any concerning changes. RPM enhances patient engagement and collaboration in care decisions while helping to reduce unnecessary hospital visits and improve health outcomes.
Benefits for Patients:
- Continuous monitoring of health metrics without needing to visit a clinic.
- Timely interventions and alerts that can prevent serious health issues.
- Increased engagement and involvement in their healthcare decisions.
- Enhanced peace of mind knowing their health is being actively monitored.
Benefits for Providers:
- Efficient management of chronic conditions through real-time data.
- Improved ability to respond quickly to changes in patient health.
- Reduction in unnecessary hospital visits and associated costs.
- Increased focus on preventive care, leading to better patient outcomes.
Transitional Care Management
Our Transitional Care Management service ensures that patients receive the support they need during critical transitions between healthcare settings, such as from hospital to home. We provide thorough follow-up consultations, medication reconciliation, and personalized care coordination for at least 30 days after discharge. By focusing on preventing readmissions and enhancing continuity of care, our TCM program helps patients navigate their recovery process more smoothly and confidently.
Benefits for Patients:
- Reduced anxiety during hospital-to-home transitions with dedicated support.
- Fewer hospital readmissions, resulting in better recovery experiences.
- Personalized follow-up care tailored to individual needs and concerns.
- Improved medication adherence through detailed medication management.
Benefits for Providers:
- Greater efficiency in managing post-discharge care.
- Enhanced patient compliance and health outcomes, leading to potential cost savings.
- Improved communication between healthcare settings, reducing potential errors.
- Strengthened patient-provider relationships through dedicated follow-up.
Behavioral Health Integration
At National Chronic Care Management, we recognize the importance of addressing mental health within the broader context of overall health. Our Behavioral Health Integration service facilitates the seamless integration of mental health services into primary care, providing patients with comprehensive care that addresses both physical and emotional well-being. We work closely with patients to develop tailored treatment plans that include therapy, medication management, and ongoing support to promote healthier lifestyles and improved mental health outcomes.
Benefits for Patients:
- Holistic treatment that addresses both physical and mental health needs.
- Increased access to mental health resources within a familiar setting.
- Enhanced support through collaborative care among healthcare providers.
- Reduced stigma associated with seeking mental health services.
Benefits for Providers:
- Improved ability to monitor and manage co-occurring physical and mental health conditions.
- Enhanced patient satisfaction through comprehensive care delivery.
- Opportunities for collaborative practices between mental health and primary care teams.
- Reduced overall healthcare costs through integrated services.
Principle Care Management
Our Principle Care Management service focuses specifically on the careful management of one complex chronic condition. We develop individualized care plans that address the unique needs of each patient through regular assessments, proactive monitoring, and educational resources. This targeted approach ensures that we effectively manage symptoms and complications while empowering patients with the knowledge and tools necessary for better self-management of their health condition.
Benefits for Patients:
- Focused care that addresses the complexities of their specific chronic condition.
- Personalized education and support to improve self-management skills.
- Regular follow-ups to track progress and make necessary adjustments.
- Enhanced understanding of their condition and treatment options.
Benefits for Providers:
- Streamlined care protocols tailored to managing specific conditions.
- Improved health outcomes through targeted interventions.
- Better patient engagement with personalized support and education.
- Enhanced data collection for outcomes tracking and quality improvement.