For the Provider
Chronic Care Management
Chronic care management services, 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:
Multiple (2 or more) chronic conditions, expected to last at least 12 months, or until death of the patient.
Chronic conditions place the patient at significant risk of death, acute exacerbation/decomposition, or functional decline
Comprehensive care plan established, implemented, revised, or monitored.
Our care team becomes an extension of the office by integrating directly into the EMR system. All information is documented in real time within the patient chart.
Every month, the Cariatrix care coordinators perform medication reconciliation, along with documenting any tests, vaccinations, and visits with specialists.
We Provide Support
Each care coordinator performs the required 20 minutes of care coordination/patient/month. This includes creating the care plan and communicating with patients monthly.