Chronic Conditions Management
401 Bicentennial Way
Santa Rosa, CA 95403
The Chronic Conditions Management program believes that our members are the most important part of the health care team. We use best practices (high-quality treatment recommendations) in supporting the prevention and self-management of chronic conditions. Our goal is to provide members with quality medical care through education and personalized health management. Living with a chronic condition can be difficult, and we are committed to helping our members live a happier and healthier life.
- Chronic Care Coordination
- Diabetes Care Management
- Heart Failure Program
- HIV Case Management
- Outpatient Medical Social Work
- PHASE Program / Diabetes Care Management
- Travel Program
- Life Care Planning Palliative Care
What We Do:
- Support “Best Practices” and prevention for chronic conditions
- Request annual lab tests and blood pressure checks
- Ask members to attend classes and groups
- Prescribe appropriate medications
- Facilitate member education and suggest lifestyle changes
- Promote health behavioral change
- Provide care management through the Chronic Conditions Management programs
Level I care helps members who are able to self-manage their chronic conditions. Patients benefit in this level by attending emphasizing self-management.
Level II care helps members with asthma, CAD, CHF, COPD, diabetes, or vascular disease who need short-term care management support. Level II health care includes:
- Health care delivered by care managers and physicians
- Participation in one-on-one visits, group visits, and telephone support
Members must be referred by their primary care provider. This level may require a co-pay.
The Health Education Department offers many related . Many people learn best in a group when they can ask questions and meet other people who are dealing with the same issues.