Chronic Care Management (CCM)

Chronic Care Management (CCM) is a Medicare-approved program that offers continuous, coordinated care for patients with two or more chronic conditions that are expected to last at least 12 months or longer. The program is designed to:

• Improve overall health outcomes
• Enhance quality of life
• Reduce unnecessary hospital visits and ER trips
• Ensure better management of medications and treatments

With CCM, our patients receive monthly check-ins, personalized care plans, medication oversight, and 24/7 access to healthcare professionals to help manage their chronic conditions effectively.

Who Qualifies for CCM?

Medicare beneficiaries who have two or more chronic conditions that may significantly impact their health qualify for CCM. Some common conditions that benefit from CCM include:

• Diabetes
• Hypertension (High Blood Pressure)
• Heart Disease & Congestive Heart Failure (CHF)
• Chronic Obstructive Pulmonary Disease (COPD) & Asthma
• Arthritis & Osteoporosis
• Chronic Kidney Disease (CKD)
• Obesity & Metabolic Syndrome
• Depression & Anxiety
• Dementia & Alzheimer’s Disease

If you or a loved one struggle with multiple chronic health issues, CCM can provide the structured support needed to stay healthier, longer.

How Our Chronic Care Management Program Works

• Personalized Care Plans
  • Medication management & prescription coordination
  • Treatment goals and progress tracking
  • Dietary & lifestyle recommendations
  • Referral coordination with specialists
• Monthly Check-Ins & 24/7 Access
  • At least one monthly check-in via phone or telehealth
  • 24/7 access to healthcare professionals for urgent concerns
• Medication Management
  • Track prescriptions and refills
  • Identify potential medication interactions
  • Ensure proper dosages and adherence
• Appointment & Care Coordination
  • Manage specialist appointments, lab work, and referrals
• Preventative Care & Health Monitoring
  • Monitor health trends and catch warning signs early

Why Enroll in Chronic Care Management?

• Better Health Outcomes – Continuous monitoring helps prevent complications.
• Fewer Hospital Visits – Regular check-ins help catch issues early.
• Improved Medication Adherence – Stay on track with prescriptions and treatments.
• Lower Healthcare Costs – Avoid unnecessary ER visits and hospitalizations.
• Enhanced Quality of Life – Enjoy better mobility, energy levels, and independence.

CCM helps patients stay healthier while reducing stress for families and caregivers.

Why Choose James E. Race, MD, PA for Chronic Care Management?

• Compassionate, dedicated care coordinators
• Personalized treatment plans based on each patient’s needs
• Advanced telehealth and patient portal access
• A focus on preventative care to keep patients out of the hospital

Take Charge of Your Health Today

If you or a loved one are living with multiple chronic conditions, you don’t have to manage it alone. Our Chronic Care Management program is here to support you every step of the way.

Call us at (214) 467-3832 to learn more or enroll today!

Visit www.jameseracemd.com for more details.

Let James E. Race, MD, PA help you take control of your chronic conditions and live a healthier, fuller life.