• Chronic Care Management 



  • New Vision offers Chronic care management to patients with Medicare and home visits to those who are homebound. CCM is a specific care management service that is designed for patients with two or more chronic conditions for a continuous relationship with their care team. CCM increases access to resources, wellness support, reduces emergency room visits, hospitalization, and readmissions. This allows us to be proactive with your healthcare needs. We understand, it takes a village!

    CCM includes the following

    • Comprehensive care plans
    • Interactive remote communication management
    • Medication management
    • Coordination of care between different providers and patients. 
  • Chronic conditions that meet the criteria for CCM

      • Alzheimer's disease
      • Arthritis
      • Asthma
      • Cancer
      • Cardiovascular disease
      • Diabetes
      • Dementia
      • Depression
      • Heart disease
      • Hypertension
      • Multiple sclerosis
      • Spinal Cord Injuries
    • Remote Patient Monitoring (RPM)

      RPM, or Remote Physiologic Monitoring, is a tool that is used to collect and analyze of patients’ physiologic data that are used to develop and manage and treatment plans related to chronic and/or acute health illness or condition. These chronic conditions includes hypertension, diabetes, heart failure. Devices used are blood pressure cuffs, glucose meters, and weight scales. With these devices, patient data is collected daily and provided to healthcare providers to see patients’ health trends. These devices have helped to reduce emergency room visits, hospitalization and re-admission.

      Transitional Care Management (TMC)

      As clients transfer from acute and/or post-acute care settings back into the communities, the process can be fragmented and as a result this can be detrimental to clients with complex care needs. Transitional care is there to prevent the care gap that exist between the “handoffs” from the hospital to the outpatient care teams. Our well trained and experienced advanced level providers are there to bridge the gap by connecting the pieces from the acute and/or post-acute care settings safely back to the communities. Our comprehensive plan of care is design to prevent unnecessary readmissions.