Chronic Care Management (CCM) is a Center for Medicare & Medicaid Services (CMS) program that allows physicians to provide care management for patients with multiple chronic diseases. You can learn more about the CMS CCM program by visiting the CMS website.

We don’t recommend this since HomeCare provides CCM or similar services.

We start with the patient’s consent. Once we have consent, our clinical team begins a patient assessment to identify chronic care concerns. After our assessment, we create a comprehensive care management plan that is part of the patient’s Sciometrix Hi-Touch CCM Program. We follow up with each patient for program progress, overall living, and medical conditions. We provide education on applicable chronic conditions, as well as information about community resources or referrals. Our team is there to help with future appointments, transportation, food vouchers, and much more.

No, not at all. Most patients enrolled in the Sciometrix CCM program have better engagement with their doctors. Sciometrix helps patients stay on track, so patients are less likely to miss medical appointments, be more prepared for appointments and return for follow-up appointments. Sciometrix CCM program has seen almost 20% or more increase in office visits due to patients increased awareness of health conditions.

Sciometrix Clinicus^TM analytics algorithm understands CCM rules and guidelines and reviews each patient’s daily activities. Based on those activities, Clinicus will flag and recommend program adjustments, which enables our health coaches to focus on matters which may have been missed.

Yes, we work closely with physicians. Our program provides patient progress, assessments, individualized care management plans, and activities that are securely stored in a patient’s electronic health record (EHR) maintained by their physician. Additionally, our health coaches will mail or contact a physician’s office for any clinical needs that the patient may require. We directly book patient medical appointments that are linked to their physician’s EHR.

Yes, the two programs complement each other and can provide a more robust wellness program for patients with chronic diseases.

We provide a turn-key solution for CCM that provides patients with a program that significantly increases their wellness engagement, resulting in better outcomes. Our care management program implementation has no upfront cost to healthcare practitioners and helps offices reserve their resources for patient clinical needs. We help a physician’s practice reduce the daily burden of monitoring and other CCM program essentials, so they can spend more clinical time with their patients.