Get Started with CCM
Launch turnkey chronic care management with zero upfront software investments. Our dedicated care team integrates directly into your existing clinical workflows to deliver measurable patient outcomes.
1. Patient Identification & Eligibility
We screen and verify eligible Medicare and Medi-Cal patients with two or more chronic conditions.
2. Patient Consent & Care Plan
Our licensed coordinators complete informed consent and develop an individualized comprehensive care plan.
3. Monthly 24/7 Clinical Coordination
Continuous monthly remote check-ins, medication reconciliation, and seamless provider communication.
Active Care Coordination
Streamlined enrollment & dedicated patient touchpoints
Comprehensive Care for Chronic Conditions
Empowering patients and clinical practices through proactive, continuous monitoring, structured remote oversight, and individualized treatment plans tailored for lasting health stability.
Telehealth Integration
Continuous Patient Engagement
Care Specialist
Assigned & Monitored
20+ min monthly clinical oversight
Early Detection
Proactive interventions
Continuous Vitals Monitoring
Real-time biometric tracking & alerts
Dedicated Care Coordination
Monthly structured clinical check-ins
Personalized Care Plans
Tailored multi-condition management
Comprehensive Support for Complex Health Needs
Our structured Chronic Care Management services deliver structured, continuous coordination that connects physicians, care managers, and patients between regular clinic visits.
Coordinated Patient Care & Continuous Oversight
We bridge the gap between visits through synchronous telehealth consultations, specialist data sharing, and centralized chronic disease monitoring dashboards.
Dedicated Clinical Care Team
Direct access to licensed nurses and designated care coordinators.
Real-Time Metric Alerts
Immediate notifications when patient vitals move beyond safety targets.
HIPAA Compliant Workflows
Secured encrypted exchange adhering strictly to healthcare privacy.
Telehealth Consultations
Frequent touchpoints with licensed care managers.
24/7
Care Team Accessibility
94%
Care Plan Compliance
Chronic Disease Monitoring
Continuous vitals, lab reports, and trend analysis.
Multidisciplinary Team Care
Coordinated specialist care plans.