A chronic illness can negatively impact your life, but when managed, your body can function well, allowing you to enjoy your daily routine and quality of life. See the experts at Passion Health Primary Care for chronic care management in Irving, Plano, Frisco, Prosper, Aubrey, Kemp, Kaufman, Flower Mound, Forney, TX. Shyamala Arani Purushotham MD, FACP, CPHQ, Pooja Naik, MD, and expert team of chronic care specialists can help reduce your risk of complications from chronic conditions and improve how you feel. To learn more, call our friendly office staff today or use the convenient online booking feature.
Chronic care management offers a combination of routine checkups, patient education, and prescription medication to help relieve the symptoms associated with chronic illnesses.
Passion Health Primary Care provides this service to relieve symptoms and help you thrive. Chronic care management can prevent your chronic condition from progressing or worsening and help you live a healthy, vibrant life.
Chronic care management treats various conditions, including:
You can also benefit from chronic care management if you suffer from chronic gastrointestinal issues, such as Crohn’s disease or ulcerative colitis.
Passion Health Primary Care’s chronic care management focuses on:
The more you know and understand your condition and how to manage it, the better results you will have. The team provides education about your diagnosis and offers guidance on how to be proactive about your customized plan to help you feel better.
Your provider might prescribe medication that aligns with your needs. Before they offer a prescription, they review your medical history and perform a series of tests.
A healthy lifestyle can offer one of the best ways to positively impact your condition. The team may recommend a balanced diet, regular exercise, plenty of sleep, and ways to manage your stress levels.
The Passion Health Primary Care team also offers remote patient monitoring services to maximize the health benefit of chronic care management.
Remote patient monitoring allows your provider to check on you and provide timely interventions as needed to avoid complications. They give you devices specific to your chronic disease that collect data about your condition, which gets submitted to your provider in real time.
The easy-to-read reports give your provider a picture of your health and show how your body is responding to your treatment plan. Patients benefit from this level of support to maintain excellent chronic care management and a fulfilled life.
If you’re ready to receive the care you need for your chronic condition, don’t delay. Call Passion Health Primary Care today, or go to the contact page online and click “request appointment” now.
Chronic care management (CCM) is ongoing medical support for patients with long-term conditions. It includes monthly follow-ups, care coordination, medication support, and personalized care plans to help prevent complications.
It means your care team supports you between visits, not just during appointments, to keep your conditions under control.
CCM services include care planning, medication review, symptom monitoring, coordination with specialists, lab follow-ups, and post-hospital care support.
A CCM program is a structured monthly service provided by your primary care team to help manage multiple chronic conditions and improve quality of life.
A CCM plan is a personalized plan outlining your conditions, goals, medications, monitoring needs, and steps to take if symptoms worsen.
Patients with two or more chronic conditions expected to last at least 12 months and that increase the risk of health decline may be eligible.
Patients with conditions such as diabetes, high blood pressure, heart disease, asthma, COPD, arthritis, thyroid disorders, anxiety, or depression—especially when multiple conditions are present.
Common qualifying conditions include asthma, arthritis, osteoporosis, heart disease, chronic kidney disease, COPD, diabetes, anxiety, depression, and chronic gastrointestinal disorders.
CCM includes non-face-to-face monthly care such as care coordination, patient communication, medication support, and care plan updates.
CCM helps reduce complications, improve symptom control, prevent hospital visits, and support long-term health.
CCM keeps patients consistently connected to a primary care team, improving preventive care and ongoing management of chronic conditions.
Each month, the care team reviews your health, follows up on symptoms, coordinates care, updates your plan, and contacts you as needed.
A CCM nurse provides monthly check-ins, reviews medications and symptoms, coordinates care, and communicates updates to your provider.
Telephonic CCM delivers care coordination primarily by phone, making it convenient for patients who prefer support from home.
Yes. Medicare covers chronic care management for eligible patients. Standard copays or deductibles may apply.
Payment varies based on the service provided and location. Patients typically pay a small monthly copay.
Coverage depends on the state and specific Medicaid plan. Some plans cover CCM-related services.
Medicare, many Medicare Advantage plans, and some commercial and Medicaid plans cover CCM.
Billing is handled by the clinic and includes documented monthly care coordination and follow-up time.
Physicians and qualified healthcare professionals bill CCM, with support from trained clinical staff.
Program Setup & Improvement
A CCM program includes identifying eligible patients, obtaining consent, creating care plans, monthly outreach, and proper documentation.
Successful CCM uses consistent monthly follow-ups, clear workflows, medication reviews, and coordinated care.
CCM improves with better patient engagement, closing referral gaps, simplifying treatment plans, and addressing lifestyle and social barriers.
Clear communication, regular check-ins, personalized goals, and easy access to the care team improve patient outcomes.
Nursing / Education
“I should wait until the pain becomes severe before giving pain medication.”
Chronic pain is best managed with timely, consistent treatment rather than delayed intervention.
Passion Health Primary Care offers Chronic Care Management to help patients in Irving, Plano, Frisco, Prosper, Aubrey, Kemp, Kaufman, Flower Mound, Forney, and nearby areas manage long-term conditions with compassionate, consistent support.
Care with Compassion. Care with Consistency.
Medical Disclaimer – FAQ Content
The information provided on this FAQ page is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. Content related to high cholesterol, diet, supplements, medications, and lifestyle is general in nature and may not apply to every individual.
Health conditions such as high cholesterol, heart disease, diabetes, and hypertension vary based on personal medical history, genetics, and other risk factors. Always consult a licensed healthcare provider before making changes to your diet, exercise routine, supplements, or medications.
Reading this content does not establish a physician–patient relationship. Do not disregard or delay professional medical advice because of information found on this website.
If you are experiencing symptoms such as chest pain, shortness of breath, dizziness, or other urgent medical concerns, seek immediate medical attention or call emergency services.
