Customized Care Management Services

Customized Care Management Services At CCMS we help to avoid complications and readmission to the hospital by providing customized clinical oversite for 30 days from date of discharge. Our Transitional Care providers, patients and their families have access to a healthcare provider that is familiar to them and their case, 24 hours a day, 7 days a week. Patients also have access to their medical information through the patient portal. We also believe that patients can prevent health crisis with proper care. We offer initial assessments and integrative health solutions that look at the patient as a whole. We believe that patients are not their disease or diagnosis therefore we listen and cater to their unique needs and care for them mind, body, and spirit. Our goal is to Develop and maintain community partnerships, create an effective and appropriate educational curriculum for our patients, and establishing a relationship with families before conducting a home evaluation. Our customized approach to patient-family based medical care allows for us to provide individualize member interventions, referrals, and education to meet specific health needs. At CCMS we partner with Medicare, Health Plans, MSO’s and ACO’s to identify the patients who need personalized medical intervention then we stratify those that will benefit from program. We also have a self pay option for all of our services. Our commitment to provide exceptional care to patients and their families are founded on the principles of meeting patients where they are medically and optimizing their care in collaboration with the medical team. This will further reduce the risk adverse events, decrease unnecessary return visits to the hospital or emergency room, and also increase patient knowledge and understanding of their health conditions.