Chronic Care Management Service
Helping Patients Feel Supported Between Visits
Chronic conditions cannot be managed by a patient alone. Once they have left your office, life becomes hectic, the symptoms change, and you find it difficult to continue to take medications, to conduct follow-ups, or change lifestyle. Most patients just require an individual to visit them, listen to them a bit and ensure they are okay. Halo Practice Solutions comes in at that point. Our Chronic Care Management Service provides your patients with continuous monthly support and takes off the burden on your staff. We keep in touch with them between appointments and assist them in adhering to their care plans and give them clear documentation that your practice can rely on. It is a pragmatic, caring format that keeps patients on track and providers in order.
Halo Practice Solutions comes in at that point
Our chronic care management service provides your patients with continuous monthly support and takes off the burden on your staff. We keep in touch with them between appointments and assist them in adhering to their care plans and give them clear documentation that your practice can rely on. It is a pragmatic, caring format that keeps patients on track and providers in order.
Stable Monthly Revenue
Medicare covers the time spent on CCM per month by the providers. This provides a stable stream of revenue which contributes to the long-term financial stability of the practice.
Less Administrative Burden
Your employees do not need to fit follow-up calls or reminders into their already busy schedule. Halo does the communicating, tracking and documentation and your team is working on direct care.
Better Continuity of Care
Chronic Care Management: What Is It?
The Chronic Care Management (CCM) is a program that is created to address individuals with two or more chronic diseases who are anticipated to remain at least a year long. Some of the conditions may comprise diabetes, high blood pressure, COPD, arthritis, heart disease, among others.
The goal is simple:
Assist patients to cope with their conditions, month after month.
CCM generally includes:
● Monthly check-ins
● A personalized care plan
● Guidance on medications
● Lifestyle modification assistance
● Monitoring symptoms and issues
● Organizing interactions with other providers
Medicare endorses CCM since regular touch points will result in improved outcomes and avoidable complications.
The Reason CCM is Important to the Patients of the Present Day
Every year, chronic illness is on the increase. A lot of patients have difficulty in adherence to treatment, remembering appointments, or not understanding what to do when the symptoms vary. Even when something is wrong, they may not necessarily contact them.
Monthly CCM support provides them with:
● A steady point of contact
● A listening person not in a hurry
● Assistance in simplifying care instruction
● Provision of motivation during periods of doubt
● Individual instruction when not in the clinic
In your practice, it will give you a more convenient way of dealing with long-term conditions with fewer unnecessary ER visits and hospitalization.
The rationale behind why your practice needs to provide a chronic care management service.
CCM is not only a program, it is also a pragmatic approach to helping patients as well as enhancing clinical and financial stability. This is why it is used by numerous clinics:
Better Patient Outcomes
Patients that undergo frequent CCM check-ins are more likely to adhere to their care plans. They have a better understanding of their medications, they are more involved in their health, and they are more ready to deal with the symptoms before they begin to worsen.
Our Chronic Care Management Services
Halo offers a comprehensive CCM solution that is built on the requirements of your patients and the workflow in your clinic.
Admission and Patient Identification
Your team can use us to assist in the identification of qualified patients and also assist you to take them through the consent process. This will make sure that all patients that qualify and wish to be assisted are registered in the right manner.
Care Plan Development
Each of the patients is provided with an individual care plan. It has their health targets, medication, day to day problems, and instructions on how to remain healthy at home. The plan is revised according to their needs.
Record Keeping & Electronic Health Records
We document every activity, time-monitor, and ensure that all the information is well represented in your EHR. This facilitates hassle free billing and uniform record keeping.
Monthly Care Coordination
Our care coordinators also contact our clients monthly to check in and respond to questions, discuss medications, and offer practical assistance. These are informal conversations that are basic and centered on the immediate needs of the patient.
The Fit of Our CCM Workflow in Your Practice
An effective CCM process is to be natural, not as an additional work. The following is the way our workflow integrates with yours:
Recognize and Admit Eligible Patients
Ethan, the patient information and necessary consent are collected by us and your staff together.
Provide Monthly Support
Patients are followed up, reminded and coached based on their conditions.
Maintain Care Plans
The plans are also recapitulated and modified depending on the progress and feedback of the patient.
Measure Time and Develop Document
All the minutes used are properly documented to ensure that your billing department gets everything they require.
Deliver Reports & Updates
You will have concise summaries of patient engagement, progress and performance of the program.
Patient and Practice Benefits
When CCM is properly administered, there is actual difference in both groups.
Reduced ER Visits
Constant monitoring will assist in identifying issues at an early stage before they become severe.
Better Self-Management
Hospitals make patients more aware of their care plan and remain loyal to their objectives.
Less Stress on Your Staff
Your staff has to make fewer regular calls and spend more time on patient care.
Reduced ER Visits
Constant monitoring will assist in identifying issues at an early stage before they become severe.
Better Self-Management
Hospitals make patients more aware of their care plan and remain loyal to their objectives.
Less Stress on Your Staff
Your staff has to make fewer regular calls and spend more time on patient care.
Improved Patient Relationships
When a person visits them frequently, not only when it is time to see them, people feel more appreciated.
Populations and Specialties of Patients We Serve
Our program is designed for:
- Primary care
- Family medicine
- Internal medicine
- Geriatric care
- Multi-specialty groups
- Telehealth practices
We are flexible depending on the needs of your patients and the manner in which your clinic is running.
Why Select Halo Practice Solutions to CCM?
The selection of a CCM partner is a long-term process. Halo offers:
- An amiable group of chronic care support trained personnel.
- Trustworthy, HIPAA-compliant procedures.
- Easy compatibility with the majority of EHRs.
- A practice specific program.
- Effective communication and documentation that can be understood.
In case it is required, your CCM may be supported by Medical Transcription Services or Virtual Medical Scribing Services that provide your practice with additional aid in documentation and communication with patients.
How It Works:
Patient Enrollment
Patients with two or more chronic conditions are enrolled in the program
Care Plan Setup
Our clinical team develops a personalized care plan approved by you.
Ongoing Support
Patients receive regular calls, reminders, and health monitoring.
Progress Tracking
We collect and share data on patient health, compliance, and outcomes.
Collaboration with Providers
Updates are shared with you, so you stay informed and involved.
Improved Staff Efficiency
Your team can focus on in-clinic care instead of follow-up calls or data tracking.
Flexible and Scalable
The service adapts to your practice size and patient needs.
Regulatory Compliance
We follow all legal and billing rules, including Medicare guidelines for CCM.
Benefits of Halo’s Chronic Care Management Service
Better Patient Better Results
Ongoing support helps patients manage their conditions better.
Happier patients
Regular check-ins show patients they’re cared for.
Reduced Hospital Visits
Proactive care helps prevent avoidable ER trips and hospital readmissions.
Clear Documentation
We keep accurate records, making billing and audits easier.
Start Supporting Your Patients Between Visits
Halo Practice Solutions helps your practice deliver steady, meaningful support to patients who need it most. Our chronic care management service keeps patients engaged and gives your clinic a reliable, organized way to manage long-term conditions.
Ready to learn more? Contact us today for a free consultation.
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Frequently Asked Questions (FAQs)
Anyone with two or more chronic conditions that are expected to last for at least 12 months.
Yes. Our team handles the calls, provides support, and documents each interaction.
Yes. We integrate with most EHR systems and keep everything organized.
Yes. Our workflow follows all required CCM documentation and privacy standards.