Chronic Care Management

Coordinated Care That's Always There

Chronic Care Management

Chronic Care Management is a new Medicare service offered by Northwestern Medicine that enables your primary care team to be highly engaged in managing your ongoing health. The Chronic Care Management program is designed to help you improve your health by simplifying your care and providing increased support to manage two or more chronic conditions. The benefits for you are more personalized, seamless, proactive care and better quality of life.

Our team will:

Develop a personalized, comprehensive plan for your care in a partnership with your care team - you, your
primary care physician and a dedicated Northwestern Medicine nurse
Ensure that the plan is updated regularly and is available to you and your physician at all times
Communicate at least once a month about your health on the phone or through the MyNM Patient Portal
Provide oversight for all your medications, including one-on-one coaching for how to manage your medications
Provide 24/7 access to health management tools
Coordinate care among all your providers and care team members

Who qualifies?

You must be a Medicare recipient with two or more chronic conditions. Medicare will cover the costs of Northwestern Medicine Chronic Care Management, though you may have a small co-pay.

What is a chronic condition?

A chronic condition is an ongoing medical problem that must be managed to maintain the best possible health. Examples of chronic conditions include diabetes, high blood pressure, cancer, arthritis, heart disease, hypertension, depression, and others. Please read the FAQs for a complete list of chronic conditions that are eligible.

How to sign up

Enrollment in Chronic Care Management requires an in-person appointment; please call or make an appointment online with your primary care physician. After the initial visit in-person, you can begin receiving monthly care for your chronic conditions remotely—either by phone check-in with a member of our care team or using the secure, electronic communication option offered through the MyNM Patient Portal.

Whether you live five minutes or 50 miles away, we know that making it into our office can be challenging. The Chronic Care Management program can make it much more convenient to get the consistent care that you need to stay happy and healthy. We hope that you will take the time to review the attached materials and consider the program. As your primary care team, we are excited about this new program and the potential it has to help you with your health.