Care Coordination Services

Care Management

Care Management is a program that targets specific populations. Care Managers assist patients with multiple or complex conditions to obtain access to care and services, as well as coordinate their care in order to meet health goals and improve outcomes. Click here to learn more and access program resources.

 

Condition Management

The Condition Management program is designed to collaborate with practitioners and patients to identify opportunities for prevention and intervention to provide well-coordinated care. Patients enrolled in the condition management program will work with a health coach to develop a plan of care founded on evidence-based guidelines and interventions specific to their conditions or risks. Intervention plans are tailored based on screenings, immunizations, self-management education and support, medication adherence and goal-setting. The health coach will encourage adoption of healthy lifestyle behaviors and assist the patient with referrals to support groups and condition-specific programs including diabetes self- management, medical nutrition therapy, weight management, smoking cessation, and depression. The health coach will interact with patients through phone calls or in person meetings. Educational materials are given to support all self-care efforts of the patient.

As a practitioner, the health coach will provide you with the care plan for your patient, along with updates on the progress of your patient through their electronic medical record (EMR), via fax or postal services. Utilizing this service allows you to partner and communicate with your patient’s health coach to provide feedback or concerns regarding the well-being of your patient. Unscheduled communication between you and the health coach may occur if clinical questions arise concerning the patient’s medication or if there are immediate concerns about your patient’s safety.

 

 

300 E. McBee Ave, Suite 502
Greenville, SC 29601
Hours of Operation: Mon-Fri; 8:00 a.m.-5:00 p.m.
(864) 522-2060 (P)
(864) 522-3149 (F)