Services

Care Management Services

Helping patients with long-term or complex conditions take control of their health.

The term "care management" refers to a broad range of services and initiatives that support patients with long-term or complex medical illnesses in taking control of their health. The primary objective of care management is to increase patient health. Along the way, the strategy hopes to increase patient participation, decrease hospital visits, and enhance care coordination.

As a major practice-based technique for managing the health of people with complicated or chronic medical disorders, care management has evolved. Care management programmes can enhance the standard of care and assist patients in achieving and maintaining better health by integrating systems, science, information technology, and encouragement.

Why to opt for care management?

Better clinical results.
Decreased reliance on expensive acute care services.
More appointments for primary and/or preventative care.
Fewer examinations and procedures that are repeated.
Increased patient contentment.

Programme comparison

Category	Chronic care management	Principal care management	Remote patient monitoring
Patient Eligibility	≥2 chronic conditions lasting for >12 months Example: Arthritis, Asthma, Atrial fibrillation, Cancer Cardiovascular disease, COPD, Depression, DM, HTN, HIV Alzheimer's disease and related dementia	1 complex chronic condition expected to last at least 3 months Example: the condition that places patient at significant risk of hospitalization Acute exacerbation Decompensation Functional decline Death	High BP, DM, Weight loss or gain Heart conditions, COPD, Sleep apnea, Asthma Example devices: weight scales, pulse oximeters Blood glucose meters, blood pressure monitors
Practice Requirements	Continuous patient relationship with chosen care team member Supporting patients with chronic diseases in achieving health goals 24/7 patient access to care and health information. Patient receiving preventive care. Patient and caregiver engagement. Prompt sharing and using patient health information.	Continuous patient relationship with chosen care team member Supporting patients with chronic diseases in achieving health goals 24/7 patient access to care and health information. Patient and caregiver engagement. Prompt sharing and using patient health information.	Continuous patient relationship with chosen care team member Prompt documentation and securing the data received from patient in EHR. Support should be available when the received data is alarming.
Frequency & Mode of Communication	Minimum 20 mins/month via call, text, secure email or EHR. Billed once/month if required with add-on code.	Minimum 30 mins/month via call, text, secure email or EHR. Billed once/month if required with add-on code.	Minimum 16 readings/month and/or 20 mins/month for care management coordination. Billed once/month if required with add-on code.
Eligible Professionals	Physician Physician Assistants Nurse Practitioners Clinical Nurse Specialists Certified Nurse Midwives	Physician Physician Assistants Nurse Practitioners Clinical Nurse Specialists Certified Nurse Midwives	Physician Physician Assistants Nurse Practitioners