Providing quality family care to Houston since 1998.

Chronic Care Management (CCM)

Chronic Care Management (CCM) services are non-face-to-face services provided to Medicare beneficiaries who have multiple significant chronic conditions. In addition to office visits and other face-to-face encounters, these services include communication with the patient and other health professional for care coordination (both electronically and by phone), medication management, and 24 hours a day accessibility for patients and any care providers (physicians or other clinical staff). 

​Examples of chronic conditions include, but are not limited to, the following:

● Alzheimer’s disease and related dementia

● Arthritis (osteoarthritis and rheumatoid)

● Asthma

● Atrial fibrillation

● Autism spectrum disorders

● Cancer

● Cardiovascular Disease

● Chronic Obstructive Pulmonary Disease

● Depression

● Diabetes

● Hypertension