Supporting Better Health for Seniors, Every Day

At Guide Point Senior Care, we understand that many long-term care residents live with multiple chronic health conditions such as diabetes, heart disease, COPD, and hypertension. Managing these conditions effectively requires more than periodic doctor visits—it calls for ongoing, coordinated care that keeps residents healthier and improves their quality of life.

That’s where Chronic Care Management (CCM) comes in.

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What is Chronic Care Management?

Chronic Care Management is a Medicare-supported program designed for patients with two or more chronic conditions expected to last at least 12 months. It provides comprehensive, non-face-to-face care coordination each month, delivered by our clinical team and overseen by a dedicated physician.

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CCM ensures that residents receive:

• Personalized Care Plans tailored to their specific health needs and goals.

• Monthly Check-Ins to track progress, address concerns, and adjust treatments.

• 24/7 Access to Care Coordination for urgent questions or guidance.

• Medication Management to ensure safe and effective use of prescriptions.

• Communication Between Providers so every healthcare professional is on the same page.          

Why is CCM Beneficial for Long-Term Care Residents?

1. Improved Health Outcomes
Consistent monitoring and adjustments reduce hospitalizations, ER visits, and complications from chronic diseases.

2. Seamless Care Coordination
CCM keeps physicians, nurses, specialists, and caregivers informed, creating a united care team for each resident.

3. Enhanced Quality of Life
By managing symptoms proactively, residents can enjoy greater comfort, mobility, and independence.

4. Reduced Burden on Facility Staff
Our team handles the coordination and documentation, freeing facility staff to focus on day-to-day resident needs.

5. Financial Support through Medicare
CCM is reimbursable through Medicare, ensuring access to high-quality care without added costs for residents or facilities.

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Our Commitment to Long-Term Care Facilities

Guide Point Senior Care partners with your facility to integrate CCM seamlessly into your existing care routines. Our technology-driven approach allows us to track progress, identify risks early, and respond quickly, all while maintaining a human touch that residents value and trust.

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✅ Better communication. Better outcomes. Better living.
That’s the promise of Chronic Care Management with Guide Point Senior Care.