Managing two or more long-term health conditions can involve medications, follow-up visits, lab results, specialists, and day-to-day health decisions. Passion Health Advanced Primary Care provides Chronic Care Management (CCM) to help eligible patients stay connected to a primary care team with an organized, personalized plan. Choose a North Texas clinic, select a preferred provider, and request a Chronic Care Management appointment on this page.
Select your preferred location and provider, then open the calendar to choose a preferred date and time.
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Chronic Care Management is structured, ongoing support for patients living with multiple long-term health conditions.
Chronic Care Management can include routine follow-ups, patient education, medication support, symptom monitoring, care-plan updates, and coordination with other members of your healthcare team.
The goal is to keep your care organized between visits—not just during an appointment. Your care team can review how you are doing, follow up on important health needs, help close gaps in care, and coordinate next steps when your condition changes.
Passion Health Advanced Primary Care may also use Remote Patient Monitoring when appropriate, allowing certain health information to be reviewed between visits as part of a broader chronic-care plan.
CCM may be appropriate for eligible patients with two or more chronic conditions expected to require ongoing medical attention.
Ongoing follow-up may include medication review, lab monitoring, lifestyle guidance, and coordination of preventive care.
Primary care can help track symptoms, medications, risk factors, follow-up testing, and specialist recommendations.
Regular monitoring and medication support can help patients work toward safer, more consistent blood-pressure control.
Chronic respiratory conditions may benefit from symptom follow-up, medication review, and coordinated care.
Care coordination can help organize lab follow-up, medication review, and specialist recommendations.
Long-term musculoskeletal conditions may require medication support, monitoring, lifestyle guidance, and referrals.
Ongoing primary care can help monitor symptoms, medications, referrals, and overall health needs.
CCM is designed to make complex care easier to organize when several health conditions need attention at the same time.
Request a Chronic Care Management visit to discuss eligibility, your current conditions, medications, care goals, and the support you may need between appointments.
Your care plan can combine education, medication support, lifestyle guidance, monitoring, and care coordination based on your individual needs.
Your plan may outline your conditions, medications, health goals, monitoring needs, follow-up steps, and when to contact the care team.
Your provider can review medications, discuss adherence or side effects, and update treatment when clinically appropriate.
The care team may check in on symptoms, care needs, referrals, lab follow-up, and progress toward your health goals.
CCM can help connect primary care with specialists, post-hospital follow-up, test results, and other parts of your healthcare plan.
Your provider will review your health conditions and determine whether a structured chronic-care program is appropriate for you.
Discuss the long-term conditions you are managing, recent symptoms, hospital visits, specialists, and any areas that are difficult to keep organized.
Your provider may review prescriptions, recent tests, preventive-care needs, and current treatment recommendations.
Your plan may include health goals, monitoring needs, medication support, follow-up priorities, and care-coordination steps.
When enrolled, the care team can provide ongoing follow-up and update the care plan as your health needs change.
For some patients, Remote Patient Monitoring can complement CCM by helping the care team review selected health measurements between visits.
Remote Patient Monitoring may use condition-specific devices to send health information to the care team. This can provide additional visibility into how a patient is doing between office visits and may help the provider identify when follow-up is needed.
Whether RPM is appropriate depends on your conditions, care plan, coverage, and provider recommendations. The clinic team can explain available options during your appointment.
CCM supports ongoing management of long-term health conditions, but it does not replace emergency evaluation. Call 911 or seek emergency care for severe chest pain, serious difficulty breathing, signs of stroke, loss of consciousness, or another potentially life-threatening emergency.
Chronic conditions often overlap. One organized care plan can help keep medications, monitoring, referrals, and follow-up needs from becoming disconnected.
Passion Health Advanced Primary Care can help eligible patients maintain a personalized chronic-care plan, review progress over time, coordinate with specialists, and address important care needs between routine office visits.
Insurance coverage and patient cost-sharing vary by plan. Medicare covers Chronic Care Management for eligible beneficiaries, and copays or deductibles may apply. The clinic team can help review your specific coverage and eligibility.
Choose a clinic, select a provider, and submit your preferred appointment date and time.
Choose the Passion Health Advanced Primary Care clinic that is most convenient for you.
Review provider photos and select your preferred clinician or choose any available provider.
Open the calendar, select your preference, and complete the short Chronic Care Management request form.
Chronic Care Management is ongoing medical support for eligible patients with multiple long-term conditions. It may include a personalized care plan, medication support, monthly follow-up, monitoring, and care coordination.
Patients with two or more chronic conditions expected to last at least 12 months and that place them at increased risk of health decline may be eligible. The clinic team will review your individual situation.
CCM may include care planning, medication review, symptom follow-up, coordination with specialists, lab follow-up, post-hospital support, and updates to your care plan.
Medicare covers CCM for eligible patients. Standard copays or deductibles may apply, and coverage can vary for Medicare Advantage, Medicaid, and commercial insurance plans.
For some patients, Remote Patient Monitoring may complement CCM by helping the care team review selected health measurements between visits.
No. This page lets you request a preferred date and time. The clinic team confirms final appointment availability, program eligibility, and coverage details.
Choose your clinic and provider, then request a Chronic Care Management appointment.
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