Chronic Care Management

Chronic conditions develop over an extended period and are often influenced by a combination of genetic, environmental, and lifestyle factors. The causes of chronic conditions can vary widely depending on the specific health condition. Common chronic conditions include heart disease, diabetes, obesity, and respiratory conditions.

According to the Centers for Disease Control and Prevention (CDC), as of 2020, approximately 6 in 10 adults in the United States have at least one chronic condition which is 60% of the patients, and 4 in 10 adults have two or more chronic conditions.

A patient with a specific Chronic condition for a prolonged duration requires continuous medical attention, lifestyle adjustments, and self-care. While there are more than 21+ chronic conditions, few of these chronic conditions require a great medical attention. Chronic Conditions listed below require ongoing medical attention, monitoring, and management.

1. Diabetes
2. Hypertension
3. Heart disease
4. Arthritis and
5. Chronic obstructive pulmonary disease (COPD)

?Patients identified with chronic conditions are required to monitor various aspects of their health regularly. The specific parameters to monitor can vary depending on the type of chronic condition, but here are some common areas that patients may need to check

1. Vital Signs: Blood Pressure: Regular monitoring is crucial for conditions like hypertension. Heart Rate: Especially important for individuals with heart conditions. Respiratory Rate: Important for respiratory conditions like COPD.
2. Blood Glucose Levels: For individuals with diabetes, regular monitoring of blood glucose levels is essential to manage and adjust insulin or other medications.
3. Weight: Regular weight checks may be necessary for conditions such as heart failure or obesity.
4. Medication: Patients need to ensure they are taking their medications as prescribed.
5. Symptoms and Pain Levels: Regular assessment of symptoms associated with the chronic condition, such as pain levels, shortness of breath, fatigue, etc.
6. Diet and Nutrition: Monitoring dietary habits, especially for conditions like diabetes or heart disease.
7. Physical Activity: Tracking exercise or physical activity, as regular movement can be beneficial for many chronic conditions.

?CallCare24 offers a comprehensive coordinated healthcare service for individuals who are identified with chronic conditions through Chronic Care Management Plan (CCM).

?The goal of chronic care management is to improve the overall health and quality of life for individuals with chronic conditions while minimizing the impact of their conditions on their daily lives. This type of care is typically provided by a healthcare team that may include physicians, nurses, pharmacists, dietitians, and other healthcare professionals.

?Chronic Care Management Plan includes:

1. Care Plans: Design personalized care plan that outline specific goals, interventions, and strategies for managing the patient's chronic condition.
2. Care Coordination: Coordinating care among different healthcare providers to ensure a seamless and integrated approach to managing the patient's health.
3. Medication Management: Ensuring that patients are taking their medications as prescribed, monitoring for potential side effects, and adjusting treatment plans as needed.
4. Regular Monitoring: Live Dashboards which collect real-time data from tele devices allows the healthcare providers to regularly track and monitor the patient's health status, including vital signs, lab results, and other relevant indicators.
5. Remote Monitoring Technology: Platform is connected to all needed tele devices to remotely monitor patients and gather real-time data on their health status.
6. Communication and Support: Open communication between healthcare providers and patients, and providing ongoing support to help patients cope with the challenges of managing a chronic condition. Patient can engage with Providers through Chat/Call/Virtual Connect.
7. Preventive Care: Emphasizing preventive measures to reduce the risk of complications and hospitalizations associated with chronic conditions.
8. Patient Education: Providing education and resources to patients to help them better understand their conditions, manage their symptoms, and make informed decisions about their healthcare.

Chronic care management is reimbursed through specific healthcare programs and initiatives, and it plays a crucial role in improving outcomes for individuals with chronic conditions while controlling healthcare costs by preventing avoidable hospitalizations and complications.