Comprehensive intake — full review of your conditions, medications, labs, and care history.
Proactive, coordinated care for patients living with complex or multiple chronic conditions.
What is it
Managing Chronic Conditions With You
Living with a chronic condition requires more than a prescription — it requires a partner. Our chronic care management program provides structured, ongoing support for patients with diabetes, hypertension, heart disease, COPD, and other complex conditions. We coordinate your care, monitor your progress, adjust your treatment plan, and help you build the habits that lead to better long-term outcomes.
Conditions We Manage
Type 2 diabetes & prediabetes
Hypertension (high blood pressure)
Hyperlipidemia (high cholesterol)
Coronary artery disease
Heart failure management
COPD & chronic asthma
Chronic kidney disease
Obesity & metabolic syndrome
Hypothyroidism & thyroid disorders
Osteoporosis & bone health
Depression & anxiety (co-management)
Multiple chronic condition coordination
What to Expect
Personalized care plan — evidence-based protocols, medication optimization, and lifestyle goals.
Regular monitoring — scheduled follow-ups, lab reviews, and care plan updates every 90 days.
Insurance & cost
Chronic care management visits are covered by Medicare and most insurance plans. CCM billing codes available for eligible patients.
Ready to get started?
Take the next step toward care that is personalized to your health and goals.
Schedule Your Visit