The benefits of Chronic Care Management include:

• A comprehensive care plan made just for you

• Scheduling tests, labs, or X-rays

• Getting medical equipment

• Finding community resources

• Monthly check-in calls from your nurse

• Medication refills

• Coordinated care between your Primary Care

Provider and your other specialists

• Health education and goal setting

This extra support can help you:

• Feel better and stay healthier

• Avoid hospital visits

How does Chronic Care Management work?

If you agree to enroll in the Chronic Care Management program, you will be given a dedicated nurse, who works with your Outreach Community Health Centers Primary Care Provider, to help you manage your health conditions.

You will be contacted monthly by your nurse. Your nurse is trained to discuss your chronic conditions and treatment as directed by your Provider. Your nurse will provide CCM services over the phone (land line or smart phone) or over the computer – it’s your choice. Unlike an office visit, you are free to speak with your nurse from anywhere (including the couch!). No need to worry about travel time or sitting in the office waiting room.

Frequently Asked Questions

How can I qualify for Chronic Care Management?

Medicare requires eligible patients to have two or more chronic conditions. Our staff will let you know if you meet the guidelines for eligibility. You can also call us directly at (414) 751-8059 with any questions about the CCM program and services.

When should I use Chronic Care Management?

You will be given the phone number of your personal nurse, so you can contact your nurse anytime with questions, comments, and concerns related to your mental and physical health or you can contact your nurse about refilling regular prescriptions, such as insulin or blood pressure medication, changing your appointment time with your doctor, or getting help securing community resources.

How much is Chronic Care Management?

For many Medicare beneficiaries, CCM is available at little to no cost. Please note that CCM is a cost-share program under Medicare, and any portion not covered by Medicaid, Medicare Advantage, Medigap or your secondary insurance will be billed as CCM services, and your responsibility.

Ask your healthcare provider about the benefits of Chronic Care Management and how you can enroll in the program.. Our providers can assist you in setting up medical transportation services.

Please contact Chronic Care Management at (414) 751-8059.