Here at Barbour Community Health Association, we are constantly working to turn to better healthcare—which is why we are so excited to announce one of our newest endeavors: Chronic Care Management. Ever heard of it? We didn’t think so! Luckily, Belington Medical Clinic’s Health Educator, Erica Weese, RN, was able to sit down and explain what Chronic Care Management is and who it can help.

Q: What is Chronic Care Management?
A: Chronic Care Management is a personalized program designed to assist eligible patients manage their ongoing chronic conditions. After the initial start-up visit or phone call, we draft goal-oriented care plans specific to each patient to help them tackle their health goals. These can range from simple goals like remembering to take medication to more complex goals like managing and changing diets. I spend roughly 20 minutes a month with each patient checking in on their goals and making sure they’re staying on track.

Q: Who is Eligible for Chronic Care Management?
A: To begin, we are only working with Medicare patients, specifically those who have at least two chronic conditions that will last their lifetime or at least twelve months. Some chronic conditions on this list can include Diabetes, Chronic Kidney Disease, High Blood Pressure, High Cholesterol, Cancer, and more.

Q: How do patients get started with Chronic Care Management?
A: Patients can be referred by their primary care physician to begin this program. One of the best parts of Chronic Care Management is that it can all be done over the phone. It begins with an initial phone call or visit where the patient and I review their health history and any medications they’re taking.

Q: What are some benefits for people to start Chronic Care Management?
A: There are so many benefits for people to start Chronic Care Management, the biggest being education. A big part of my job is to collaborate with the patients primary care provider and to help aid in the understanding of their health conditions, labs, medications, treatments, etc.

Q: What is the Health Educator’s Role in Chronic Care Management?
A: I’m here to educate, help, and guide. My role is to be the center of the spider web. I’m the liaison between patients and their primary care physician or any other physicians or specialists the patients see. My goal is to help the patient feel more confident in their understanding of their disease processes so that they can be a happier, healthier version of themselves.

If you or a loved one are eligible for this program, don’t hesitate to contact Erica Weese, RN, at Belington Medical Clinic or Holly Holbert, BSN, RN, at Myers Clinic.