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Chronic Care Management

Chronic Care Management In La Jolla

Chronic care management can be difficult, especially as we age. At Eldahmy Wellness, we believe in supporting the health and wellness of patients managing multiple chronic conditions. We strive to guide our community toward awareness, education, and adherence to best practices for all health and wellness issues.

Our chronic care management services are ideal for Medicare beneficiaries suffering from two or more chronic conditions. Eldahmy’s team of pharmacists is skilled in the management of a chronic care program for our eligible clients under the general supervision of a Qualified Health Plan. We can perform all aspects of chronic care management, from the collection of structured data to 24/7 access to care.

What is Chronic Care Management?

Chronic care management is defined as any care provided by medical professionals to Medicare patients with multiple chronic diseases and health conditions. Services can include in-person, face-to-face visits, as well as distance management and care. At Eldahmy Wellness, our chronic care management program is a non-face-to-face service that includes several key components.

1. Collection of structured data

Recording of structured data includes patient demographics, a list of currently prescribed medications and any medication allergies, and any problems related to the patient’s chronic condition. This information is used by Eldahmy Wellness pharmacists to inform the care plan, coordinate care, and provide ongoing clinical care to the patient.

2. Maintenance and updating of the care plan

Special attention will be given to maintain and update the care plan as needed. This includes creating and revising patient-centered care with a focus on cognitive, functional, mental, physical, and psychosocial environmental factors. Patients and their designated caregivers will be provided with a copy of the care plan. In addition, electronic access to the plan will be available for medical providers and others involved with the patient’s care.

3. Comprehensive management of care

A quality chronic care management service includes comprehensive care management, with services like the systematic assessment of a patient’s functional, medical, and psychosocial requirements, and medication reconciliation. The team of pharmacists at Eldahmy Wellness also provides direct oversight of a patient’s self-management of medications to ensure patient safety. In addition, as part of the comprehensive management of care, we can coordinate with home- and community-based service providers and document any interaction in the patient’s official management plan.

4. 24/7 access to care

Patients with multiple chronic health issues must have access to care 24/7. The chronic care management services at Eldahmy Wellness include the assurance that access to urgent care management services is available regardless of the time and day of the week. Timely contact with the patient and designated caregiver is guaranteed when you choose Eldahmy Wellness as your chronic care management service provider.

The goal of a well-crafted chronic care management program is to educate the patient on the benefits of their designated treatment plan and keep them motivated to achieve their health goals. Patient self-care is another primary focus. Our comprehensive, quality chronic care management program ensures that patients and their caregivers have access to details in the care plan and coordination for their ongoing care.

What Is a Chronic Condition?

According to the U.S. Centers for Medicare and Medicaid Services (CMS), two-thirds of Medicare beneficiaries are managing multiple chronic conditions. CMS notes that women are more likely than men to have multiple chronic conditions and that multiple chronic conditions increase with age.

Before patients can be considered to have a chronic condition, Medicare requires them to receive a service or treatment for the specific condition from a qualified medical provider. Also, the condition must last for one year or longer, require ongoing medical treatment and limit daily activities.

CMS maintains a database of predefined indicators for chronic conditions. At present, there are 21 conditions on the list:

  • Alcohol abuse
  • Alzheimer’s disease/dementia
  • Arthritis (including osteoarthritis and rheumatoid arthritis)
  • Asthma
  • Atrial fibrillation
  • Autism
  • Cancer (breast, colorectal, lung, and prostate)
  • Kidney disease
  • Depression
  • Diabetes
  • Drug/substance abuse
  • Heart failure
  • Hepatitis B & C
  • High cholesterol
  • High blood pressure
  • Ischemic heart disease
  • Osteoporosis
  • Schizophrenia and related psychoses
  • Stroke

Is Chronic Care Management Covered?

Patients who meet the Medicare requirements for being a chronic care patient will have all services related to the management of their care covered.

Effective January 1, 2015, Medicare Part B provides coverage for chronic care management plans and services. Co-insurance and deductibles may apply, so patients or their caregivers should check with their Medicare Part B insurance provider to verify any out-of-pocket costs. The team at Eldahmy Wellness can directly bill Medicare for services related to a patient’s management plan.

Challenges Associated With Chronic Care Management

Research supports the idea that patients who are directly involved with the management of their chronic conditions experience better outcomes. However, data also reveals that patients who are very ill are less engaged in their care.

Multiple chronic conditions also are a direct factor in a person becoming disabled, increasing the risk of hospitalization, medication interactions, and death.

The caring professionals at Eldahmy Wellness are equipped to meet these challenges head-on and are committed to working with the La Jolla and San Diego communities.

Why Choose Us for Your Chronic Care Management Needs

At Eldahmy Wellness, our team of caring pharmacists takes pride in their focus and commitment to establishing and maintaining a continuous relationship with the patient or caregiver to deliver optimal chronic care management services. Our goal is for the patient and caregiver to feel supported and encouraged to achieve their health goals.

We strive to lead the way toward better health and wellness for our chronic care patients, with a focus on improving their quality of life through continuous care, management, and 24/7 support. We understand that each patient — and their chronic care management plan — is unique, and as such we treat them with care and respect.

If you have questions about chronic care management services or wish to speak with our team about having Eldahmy Wellness manage your chronic care plan, contact us today.

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