Chronic Condition Management

True CCM

Reimbursed by Medicare, our service is an extension of the physician practice without any additional employees or cost. We integrate both on-going personal consultations to proactively engage patients, monitor conditions and coordinate care with pharmacy management to ensure medication adherence and protocol compliance.  

Each patient is assigned a “care team” including a personal patient care coordinator and clinical pharmacologist. The clinical pharmacologist oversees patient care including:   

Chronic Condition Management Consultation (CCM)

  • 20 Minute consult monthly and additional consults for complex cases 
  • Full compliance and documentation for CMS reimbursement 
  • An assigned caregiver builds an authentic relationship and coordinates with the physican practice to update any changes in  health conditions
  • Pharmacy oversight and coordination between all patient’s specialists 
  • Continual medication reconciliation for conflicts, over-medication and efficacy 
  • Education and monitoring for protocol compliance and adherence
  • Reimbursement under CPT Code 99490
  • Interfacing to your accounting system for billing        

Pharmacy Management

Licensed in all 50 States, we manage the medications to improve adherence and compliance to drive improved cliinical outcomes.

  • Continuous medication reconciliation and coordination between all prescribing physcian practices
  • Script renewal synchronization so patients never run out prior to physician visit for refills
  • Medications are “pre-sorted” into doses and “pre-packaged” for safety and convenience
  • Free home delivery of pre-packaged medications
  • Accepts Medicare, Medicare Advantage and most insurance plans for medication payments
  • Proactively apply Rx co-pay assistance to reduce patient expenses  

Expanding Care and Practice Revenues

  • Offloads patient calls regarding medications, pre-authorizations and script renewals
  • Delivers measurable improvement in medication adherence and associated lab results
  • Substantial reduction in patients who “self-treat”, skipping medication, miss refilling prescriptions or deferring important physician visits
  • Measurable improvement in clinical outcomes
  • Over 98% patient retention rate on program