Our Services
CHMS focuses on preventive medicine for the most vulnerable patient population.
These services include Chronic Care Management and Remote Patient Monitoring.
Chronic Care Management
CCM is a service that requires spending at least 20 minutes each month on the resident's behalf managing and monitoring their chronic conditions. This could include the following services:
-
Medication Reconciliation
-
Chart Review
-
Care Plan Creation, Support, and Management
-
Patient and/or Caregiver monthly communications
-
Coordinating with community and social support services
-
Transitional care management services
-
Communication with the provider monthly to help fill gaps in care
-
Monitoring and flagging any changes in conditions to ensure preventive and proactive measures are in place
Benefits of CCM
-
Proactive approach to filling the health gaps in resident/patient care
-
Collaboration with provider and care team to provide preventative medicine
-
Reduction in unnecessary Emergency Room Visits, Hospitalizations, and Readmissions
-
Increase in patient compliance
-
Increase in patient satisfaction and touchpoints
-
Increase in office visits
-
Increase in revenue
Remote Patient Monitoring
Qualifications:
All Medicare and Medicare Advantage insured patients. All patients with chronic and/or acute conditions that can be monitoring through a remote health monitoring device
such as (but not limited to):
-
Diabetes​
-
Hypertension
-
Hypotension
-
Asthma
-
Obesity
-
Congestive Heart Failure
​
​Requirements:
-
Patient consent
-
Initial device set-up and patient education on utilization of device
-
Device utilization of at least 2-15 times per month by each patient
-
At minimum 20 minutes of time spent monthly: reviewing transmitted data from patients, interacting with patients or care giver, provider and care team
-
Monitoring and flagging any changes in patients vitals and/or data trends to assure preventive and proactive measures are in place
Benefits of Service
-
Proactive approach to filling healthcare gaps in patient care
-
Collaboration with provider and care team to provide preventative medicine
-
Reduction in unnecessary emergency room visits, hospitalizations, and readmissions
-
Increase in patient compliance
-
Increase in patient satisfaction and touchpoints
-
Increase in office visits
-
Increase in revenue
