Serving the Needs of People Living with Chronic Illness
Care Coordination has numerous benefits to people who live with chronic illness, including:
- Improved quality of life
- Improved coordination of care
- Improved self-management through shared decision-making
Improved timing of appointments and tests
- Helps identify and minimize barriers to care
You may be referred to Care Coordination through your primary care provider, hospital staff, specialist or public health clinic. Families and caregivers may also directly refer a patient for Care Coordination services.
Tahoe Forest Health System offers two types of Care Coordination services: Chronic Care Management and Transitional Care Management.
Chronic Care Management, for those diagnosed with two or more chronic illnesses such as high blood pressure, diabetes, heart disease, arthritis, emphysema or depression, provides home visits, phone calls, e-mails and office visits. The Care Coordinator works closely with your primary care provider and will often accompany you to your doctor visits. The primary aim is to offer support and provide education regarding self-management goals.
Transitional Care Management, for those who have been diagnosed with two or more chronic illnesses, have been hospitalized, and have identified a local primary care provider, assists people with chronic conditions smoothly transition from hospital to home. It starts in the hospital and continues for 30 days after discharge.
Care Coordination is a Medicare benefit. Patients may be responsible for a 20% co-pay (approximately $8) if you do not have secondary insurance. For referral, call Jackie Griffin, RN, Care Coordinator, (530) 582-3587 or e-mail firstname.lastname@example.org.
Care Coordination is a program of the Wellness Neighborhood, a Service a Tahoe Forest Health System, encouraging you to Rethink Healthy!