Care Connections: A Chronic Care Management Program

Care Connections is a preventive service that doctors can recommend to their Medicare and Medicaid patients who may have chronic conditions such as high blood pressure, high cholesterol, diabetes, heart disease, and arthritis to name a few. Care Connections helps patients make better decisions about diet & activity.

Care Connections are members of your healthcare team. They are specially trained nurses, or other healthcare professionals who know you, your medical history, and your goals. They will connect with you every month and can help you prevent emergency room visits and hospitalizations.

Best of all, you don’t have to leave the comfort of your own home! Your care manager will visit with you in your home or by phone every month.

Medicare now encourages doctors to recommend Care Connections to beneficiaries who have multiple conditions that are very common among Medicare patients and put them at risk.

With their help, you can establish a plan that gets you to your goal, no matter how large or small.

How Care Connections Can Help

  • Monthly progress checks to ensure goals are being achieved
  • Ensuring prescriptions are current and medications are taken properly
  • Coordinating care and scheduling appointments with others such as specialists, pharmacists, and therapists
  • Arranging community services such as Meals on Wheels, home health, medical equipment, and public transportation
  • Assisting with Medicare, Medicaid, social security, disability, and medication assistance programs
  • Providing regular updates to primary care providers
  • Providing education on nutrition, medical conditions, and how to improve overall health
Care Connections
Care Connections

Developing Comprehensive Care Plans

Through the Care Connections program, an individualized, comprehensive care plan is devised for all health issues that typically includes some or all of the following elements:

  • Planned interventions
  • Community and social services needed
  • Descriptions of how services are directed/coordinated
  • Schedule for periodic review and, when applicable, revision of the care plan

Chronic care management or CCM is the provision of care management to patients with two or more chronic conditions:

  • Alzheimer’s disease and related dementia
  • Arthritis (osteoarthritis and rheumatoid)
  • Asthma
  • Atrial fibrillation
  • Autism spectrum disorders
  • Cancer
  • Cardiovascular disease
  • Chronic Obstructive Pulmonary Disease
  • Depression
  • Diabetes
  • Hypertension
  • Infectious diseases such as HIV/AIDS
  • Substance use disorders

Newman Regional Health Medical Partners at the Top of Chronic Disease Management

Newman Regional Health Medical Partners was recently recognized by the Kansas Healthcare Collaborative as one of eleven medical practice groups with a combined score in the top 25% of baseline assessments for Population Health and Chronic Disease Management, also known as the 1815/1817 Assessment.

Connect With Us

Newman Regional Health
1201 W 12th Avenue
Emporia, KS 66801
Newman Medical Plaza
1301 W 12th Avenue
Emporia, KS 66801