Chronic Care Management in Birmingham, AL
Managing chronic medical conditions such as diabetes, heart disease, COPD, obesity, high blood pressure, and many others can significantly impact your quality of life. At Complete Health in Birmingham, AL, we understand the importance of effectively managing these conditions to maximize outcomes.
Comprehensive chronic care management is designed for patients with two or more chronic conditions to help navigate the complexities of managing long-term diseases. Our proactive approach includes reviewing your medical records between visits to better coordinate care, manage prescriptions, and evaluate the overall management of your medical conditions. We are dedicated to providing top-notch care at our Birmingham, AL, primary care clinics, including Medicare-covered services.
Our providers specialize in facilitating compassionate, comprehensive, and personalized care to improve the management of your chronic health conditions and overall quality of life.
Senior primary care services are available to address the unique needs of older patients, ensuring they receive tailored care designed to meet their specific health challenges. Medicare coverage often supports these services, making it easier for seniors to access the care they need.
Benefits of Chronic Care Management
Participating in a comprehensive chronic care management (CCM) program is a great way for patients and physicians to engage and manage chronic medical conditions. The benefits of a CCM include:
- Improved access to care. The chronic care management program provides 24/7 access to care such as a nurse call line.
- Proactive care. Monthly check-ins via telephone, telehealth, or electronic means help identify issues before the need for a hospital visit.
- Reduced hospitalizations and ER visits. Preventative measures, routine check-ins, and a 24/7 nurse line can help reduce hospital visits.
- Improved health outcomes. Individual care plans are designed to help each patient reach their healthcare goals.
- Improved patient satisfaction. A healthier, longer life with lower healthcare costs and improved access to doctors are among a few reasons patients choose to participate in our CCM program.
Chronic Care Management Care Plan
A chronic care management care plan is a personalized approach that addresses the medical conditions of a patient and concerns about their treatment to help reach the overall goals of their current treatment. Personalized care plans are provided to each patient in an electronic format to give visual feedback on their treatment progress.
The main components of a chronic care management plan include:
- A comprehensive list of all medical conditions, prescriptions, and allergies.
- Documented prognosis and outcome for each condition.
- Measurable treatment goals and a strategy for managing symptoms.
- Resources and supportive measures to help each patient achieve their goals.
- Any interventions planned with a timeline to keep track of future treatments.
Providers play a pivotal role in the development, follow-up, and adjustment of chronic care plans. Our chronic care management team works closely with you to create a personalized care plan. Regular check-ins are scheduled with your doctor, nurse, and a care plan specialist to monitor your condition’s progression. Working together, our healthcare team can help patients maximize their results and provide ample feedback on treatments.
Our Approach to Comprehensive Chronic Care Management
Our primary care clinics in Birmingham, AL, such as Simon-Williamson and Greystone locations, use a holistic approach to manage each patient’s chronic condition. Our multifaceted approach involves using medication, education, communication, self-help, and complementary treatments to improve health outcomes.
This is accomplished by using a multidisciplinary team to help coordinate care and improve access to our patients. Through a team of doctors, physician assistants, nurse practitioners, and nurses, Complete Health ensures our clinics are there for you whenever we are needed.
The integration of a multidisciplinary approach allows our clinicians to check in frequently with our patients to monitor their progress, address any questions or issues that may arise, and adjust the treatment plan when needed. This enhances the personalized care provided translating into improved outcomes and patient satisfaction.
Patient Engagement and Education
At Complete Health, our patients play an integral part in controlling their chronic diseases. Therefore we focus on improving their engagement in the healthcare process through a three-prong approach.
- Empowering Patients through Education. Providing appropriate educational resources and valuable information to improve your understanding of your health conditions, empowering you to make informed decisions about your care.
- Tools and Resources for Self-Management. Similar to tuning up your car, having the right tools and resources can help manage chronic conditions by improving your health-related decisions on diet, exercise, and a healthy lifestyle.
- Patient Support Systems. While empowering a patient’s ownership of their disease, we remain only a phone call away for any questions or issues when they arise. Additionally, Complete Health works to identify community support networks to help patients cope with chronic diseases.
Technology in Chronic Care Management
- Telehealth and Remote Monitoring. Telehealth check-ins are convenient for our patients, in addition to the many devices allowing at-home testing (blood sugar levels) to be transmitted to our team without leaving the comfort of your home.
- Electronic Health Records (EHR). Improve management by alerting clinicians and patients of upcoming screening tests and providing patients access to their labs and clinic notes.
- Mobile Health Applications. Mobile phone apps can provide improved tracking of diet, exercise, vitals, and other health-related events to facilitate a healthy lifestyle.
Measuring Success in Chronic Care Management
Maintaining a high level of excellence in our chronic care management program starts by utilizing multiple assessments to continually improve the program.
- Key Performance Indicators (KPIs). Complete Health uses KPIs to measure various aspects of the program to ensure we are meeting our objectives.
- Patient Feedback and Satisfaction Surveys. The continuous review of feedback and surveys from our patients helps to identify deficiencies and improve the program, molding it into a more patient-friendly experience.
- Continuous Improvement Strategies. Implementing strategies to assess and improve the program continually provides a proactive approach to identifying and fixing issues over time.
Contact Us
Interested in enrolling in a comprehensive chronic care management program?
- Call our Complete Health Greystone office at 205-995-9909 or our Simon-Williamson office at 205-206-8200 to schedule a consultation.
- Use your patient portal to schedule a consultation.
- Additionally, you can discuss the program with your healthcare provider at your next visit and our staff can help you schedule a consultation.