Chronic Care Management (CCM)
Our Chronic Care Management (CCM) program is here to help patients who have more than one long-term health problem, even between office visits.
Who can benefit?
This service is great for seniors who:
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Have health issues like diabetes, asthma, high blood pressure, heart failure, COPD, or kidney disease
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Go to the ER or hospital a lot; Feel worried or confused about a new health problem
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Need extra help at home
How does it help?
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You get a special care plan made just for you
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A nurse checks in with you between visits to see how you're doing
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We help you work with other doctors and specialists
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You'll get tips and support to help you take care of your health
This extra support can mean fewer trips to the hospital, better health, and feeling more confident about managing your conditions!
Key Benefits of the Annual Care Visit (ACV)
Screenings and assessments help identify potential health risks before they become serious problems.
Early Detection & Prevention
Receive customized recommendations for lifestyle improvements, preventive screenings, and vaccinations based on your unique needs.
Personalized Health Plan
We will review all your current medications to ensure they are safe, effective, and properly coordinated.
Medication Review
Any necessary prescriptions will be renewed or adjusted during your visit to ensure continuous care.
Medication Refills
We help connect you with additional services such as physical therapy, nutrition counseling, or chronic care management as needed.
Care Coordination
Your provider will perform a head-to-toe assessment, including checking your blood pressure, pulse, height, and weight
Comprehensive Physical Exam
Your visit includes a check for memory loss, depression, or other mental health concerns that may affect your quality of life.
Cognitive & Mental Health Assessment
Your provider will order any necessary preventive screenings, lab work, or diagnostic tests related to your chronic conditions or health risks.
Preventive & Diagnostic Testing
Annual Care Visits (ACV)
Our Annual Care Visit (ACV) is a special check-up to help you stay healthy and manage any long-term health issues - all in one visit!
How does it work?
Before your appointment, one of our nurses who knows a lot about senior care will call you to talk about:
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What you need to stay healthy
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Your medicines
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Any yearly tests or screenings
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Your health risks
When you come in for your visit, we'll use what we learned to make a plan just for you. We'll also figure out what follow-up care you might need during the year, so you can feel your best!
Supporting Your Health Every Step of the Way — Especially After 65
At Community Halth & Wellness Partners, we love caring for our seniors! If you're 65 or older, we have special services just for you. Our team helps you stay healthy and independent by focusing on things like catching health problems early and helping you manage long-term conditions. We want you to feel your best and enjoy life every day!
