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Care Management Blog

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Insights on care coordination and value-based care.

Kathryn Anderton, BSN, RN, BC-RN, CCM

Vice President of Clinical Operations, ThoroughCare

Medicare

By: Kathryn Anderton, BSN, RN, BC-RN, CCM
November 25th, 2024

The Centers for Medicare & Medicaid Services (CMS) launched the Guiding an Improved Dementia Experience (GUIDE) Model on July 1, 2024. Running from 2024 through 2032, this program is one of the first Innovation Center care models to focus on longitudinal, condition-specific comprehensive care.

Chronic Care Management

By: Kathryn Anderton, BSN, RN, BC-RN, CCM
November 12th, 2024

Medicare’s Chronic Care Management (CCM) program supports patients in managing multiple chronic conditions, slowing disease progression, preventing costly care, and enhancing quality of life. Nurses play a crucial role in this program, particularly for high-risk, vulnerable populations.

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Chronic Care Management | Remote Patient Monitoring (RPM)

By: Kathryn Anderton, BSN, RN, BC-RN, CCM
October 22nd, 2024

Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in the US, killing more than 150,000 people each year. COPD is a progressive and incurable lung disease experienced in two primary forms: chronic bronchitis and emphysema.

Patient Engagement | Care Management

By: Kathryn Anderton, BSN, RN, BC-RN, CCM
October 14th, 2024

More than 60% of older Americans receive help from unpaid caregivers; typically, these include family, friends, or neighbors. Engaging family as part of the patient’s overall care team has been shown to improve chronic disease management, including:

Clinical Efficiency

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Patient Engagement

By: Kathryn Anderton, BSN, RN, BC-RN, CCM
September 10th, 2024

The US Center for Disease Control and Prevention defines health literacy as "the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others."

Care Management

A patient’s chronic illness journey is cyclical and complex. It's not a linear path but a continuous loop of pre-service, service, and post-service interactions with the healthcare system. Without adequate self-management, health literacy, and personal discipline, a patient’s health can deteriorate, and their condition worsens significantly.

Care Coordination

Chronic kidney disease (CKD) is growing in prevalence, impacting more than 37 million Americans. More than 100,000 of these patients begin dialysis each year and 20% of those diagnosed die from the disease or its complications. At an annual cost of $114 billion annually, CKD is one of the most expensive chronic illnesses.

Care Management

Gastroenterology is a complicated specialty that helps patients with multifaceted clinical and quality-of-life issues. Yet, these providers face increased challenges, such as falling reimbursements, increasing patient demand, and physician shortages.

Remote Patient Monitoring (RPM)

In the US, diabetes affects more than 38 million adults, making up 11.6% of the population, costing more than $306 billion in direct medical costs.