INTEGRIS Care Management Program

The Care Management Program works with the physician-led primary care team to deliver quality health services for patients with chronic conditions. In addition to assuring timely wellness and prevention screenings, the Care Coordinator provides services designed to both strengthen the physician-patient partnership and reinforce patient efforts to achieve and maintain the self-management of their chronic conditions.

Services:

The Care Coordinator’s contact with the patient may be by telephone, video or in person. Interactions frequently focus on the primary care office visit and the patient centered treatment plan. Care Coordinator services may include: 

  • Health Coaching support – providing patient education, helping patients set health goals and develop action plans to improve their self-management
  • Health Monitoring – evaluating treatment adherence, identifying patient needs, and communicating findings to the primary care team
  • Psychosocial Assessment – identifying and recommending supportive interventions for life stressors that can adversely affect health outcomes.
  • Follow-up – initiating regular contact with patients for ongoing monitoring and assessment of health status
  • Care Coordination – reviewing patient care by all involved providers to facilitate communication between health services, thereby reducing fragmented care
  • Planned Interactions – reaching out to patients needing regular wellness, preventive, and chronic illness care, scheduling recommended assessments and screenings.

For more information about the services of the IMG Care Management Program, please contact your provider.

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