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Chronic Care Management

What are chronic conditions?

Chronic conditions, or chronic diseases, are medical diagnoses that are long-lasting. The word “chronic” is used when the disease or condition lasts for one year or more. Chronic diseases require frequent medical attention and are very common. Six out of ten adults in the United States have a chronic disease, and four out of ten adults have two or more chronic diseases.

Some of the most common chronic disease diagnoses include (but are not limited to):

  • Diabetes
  • Chronic Kidney Disease
  • Cancer
  • Arthritis
  • Heart Disease
  • Obesity

How it works

You will work with our clinic team members on a regular basis, in between your regularly scheduled visits with your doctor, to create personalized care plans reflecting health goals important to you. Topics you will likely discuss include lifestyle changes, reviewing medications and care instructions, introduction to community resources, addressing barriers preventing you from achieving your goals, and coordination of care.

Why Primary Care Chronic Care Management?

Here at Family Health West Primary Care, we believe that by using our entire team to care for our patients, we provide a more holistic and personalized approach to the treatment of chronic conditions. By providing these visits in between your visits with your doctor, CCM will enable us to create a tailored care plan that changes as frequently as you need.


To qualify for CCM enrollment, you must:

  • Have two or more chronic conditions
  • Have Medicare Part B

Contact Information

Mon-Fri: 8 am - 5 pm