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Chronic Care Management

We are here to help you live a healthier life, for longer.

As a member of our Chronic Care Management Program, you will be assigned a care coordinator that will schedule check-in calls throughout the year (frequency dependent on evaluation) and assist you with all your healthcare needs. Which includes, but is not limited to:

Assist in managing your appointments

Help with medication refills or explaining how and when to take your medications

Coordinate with other doctors and members of your care team

Coordinate home health or medical equipment needs

Connect you with any community resources, if applicable

Answer general healthcare questions

Provide you with a direct line to a nurse or care coordinator

Who Is Eligible

This program is for Medicare patients with more than one chronic condition such as; diabetes, hypertension, COPD, sleep apnea, cardio vascular disease, kidney disease, and many others.

If you are interested in enrolling, please contact us and we’ll be happy to get you started.

Why Enroll

We are here to remove barriers you may face navigating the complex world of health care with nurse check-in calls and updates to your health care provider of any new developments. As a member of the program, you will have a direct line to a nurse as any questions or concerns may arise.

Every patient’s care plan is different, we customize the frequency based on your needs. The frequency can be weekly, monthly, or quarterly check-ins. Once you are enrolled, you will work with our care coordinator to establish what’s best for you.

Cost and Coverage

This service is covered by Medicare and is subject to your annual deductible and coinsurance (usually 20%). If you have a secondary or supplemental insurance plan, your coinsurance may be covered. Please call your insurance representative for more information.

Medicare Enrollment Facts & Resources

Medicare enrollment begins Oct. 15, 2024, through Dec. 7, 2024. Make sure you have all the facts about your coverage options and possible limitations before getting located in for the year.

CMS Open Enrollment Resources

Get the Facts Before Committing to Medicare Advantage

Medicare Advantage Plans Disrupting Care for Rural Seniors

Leveling the Playing Field for Rural Seniors and Hospitals

Additional Resources

MHS is a part of an Accountable Care Organization (ACO)

CMS Learn more about ACO Medicare page

AACOG benefits counseling link

Castroville FBC Pantry

Devine Food Pantry Ministry

Hondo Medina County Food Pantry

Medina Center Meals on Wheels

Methodist Healthcare Ministries

San Antonio Food Bank