Chronic Disease Management

Now this topic is in a class of its own. There are so many areas of discussion on Chronic Disease Management that range from ROI (Return on investment) to payors to codes to payments for care. It can become very convoluted and exhausting. For the purpose of this site and this service, let’s keep it simple.

HEALTH MAINTENANCE ADVANTAGE provides Chronic Disease Management. The definition under the service provisions when participating with HEALTH MAINTENANCE ADVANTAGE is a referral that falls under the Tier provisions of “High Risk or Catastrophic”. This group of clients have:

• 2 or more persistent qualifying chronic diagnoses.
• Multiple co-morbidities
• Frequent ER or hospitalizations related to the chronic disease.

This service is a higher level of care with the involvement of

• CCM’s (Certified Case Managers)
• LCSW’s (Licensed Clinical Social Workers)
• RD (Registered Dieticians)
• An increased frequency of Remote Patient Monitoring using 1 or more monitoring devices.

Chronic Disease Management under the Health Maintenance Advantage program has following goals:

• Optimize behavior change to increase the quality of life
• Improve the ability to manage self-care practices
• Prevention of exacerbations
• Lowering over utilization or unnecessary utilization of Emergency room visits or hospitalizations
• Address barriers of SDoH (Social determinants of Health)

These services are billed according to the HEALTH MAINTENANCE ADVANTAGE tier structure and contract participation guidelines.