Patient Portal

TPCA Chronic Care Management

Chronic Care Management (CCM)/Case Management

Through a partnership between you and your health care team, chronic conditions can be managed to achieve optimal health outcomes. Our CCM program is designed to help patients with two or more long-term or recurring chronic illnesses manage their health. Your TPCA primary care provider and chronic care team will work closely with you to monitor your conditions and provide comprehensive care solutions for treatment.

    Some of our Services Include:

    • Chronic Condition Monitoring (ex. diabetes, asthma, COPD, congestive heart failure, chronic kidney disease, coronary artery disease)
    • Nutrition Planning and Exercise Program Assistance
    • Smoking Cessation
    • Behavioral Modification/Stress Management
    • Medication Management
    • Obtaining DME (Durable Medical Equipment- walkers, wheelchairs, shower chairs, etc.)
    • Compliancy (lab work, diagnostic studies, etc.)
    • Community Resources and Educational Materials
    • Referrals to Physical Therapy, Speech Therapy, Occupational Therapy, Skilled Nursing, Short-Term Care, Long-Term Care, or Hospice Facilities
    • Establishment of Home Health Care and More!

For convenience, our chronic care management services are offered via telephone! If you feel that you would be a great candidate for this service, please contact your:

 

TPCA Primary Care Provider

 

CCM Staff

Alex Mazzei, RN; (850) 402-6214