Chronic Care Management

Chronic care management services help patients manage conditions such as diabetes, asthma, high blood pressure, and Hepatitis C.

woman looking out window pondering

Chronic Care Management (CCM) Eligibility:

Patients with multiple (two or more) chronic conditions expected to last at least 12 months and that place the patient at significant risk of acute exacerbation/decompensation, functional decline, or death are eligible for CCM services. Examples of chronic conditions include, but are not limited to:

  • Alzheimer's disease and related dementia
  • Arthritis (osteoarthritis and rheumatoid)
  • Asthma
  • Atrial fibrillation
  • Autism spectrum disorders
  • Cancer
  • Cardiovascular Disease
  • Chronic Obstructive Pulmonary Disease
  • Depression
  • Diabetes
  • Hypertension
  • Infectious diseases such as HIV/AIDS

Expected Benefits or Goals of Chronic Care Management:

  • Continuous relationship with a designated member of the care team
  • Improved function in work, social, recreational, and/or physical activities
  • Patient support for chronic diseases to achieve health goals
  • 24/7 patient access to care and health information
  • Receipt of preventive care
  • Patient and caregiver engagement
  • Timely sharing and use of health information

Understandings and Agreements:

  • The availability of CCM services and applicable cost-sharing (when patients have both Medicaid and Medicare, there is no out-of-pocket cost to the patient)
  • Only one practitioner can furnish and be paid for CCM services during a calendar month
  • Participants have the right to stop CCM services at any time (effective at the end of the month)
tracy tinker

Certified Diabetes Education

A Certified Diabetes Educator is available at all our locations to assist persons with diabetes. Patients can expect a variety of educational methods, hands-on charts, videos, and informational tools to help.

For an appointment with the Certified Diabetic Educator, ask your provider for a referral.


Work with your Certified Diabetes Educator to:

  • Understand exactly what diabetes is and how it affects the body
  • Understand how diabetes medications work to lower blood glucose
  • Learn about the importance of healthy eating and how to plan meals
  • Determine which glucose monitoring device will work best for them and offer education on its use
  • Learn how to use apps and other tools to track progress
  • Use skills that can help cope with stress and solve problems as they arise

High Blood Pressure

Managing your high blood pressure

Talk to your provider to find out what services you may qualify for to control your high blood pressure.

doctor talking with patient

Hepatitis C Treatment

Lamprey Health Care can treat Hepatitis C on-site. What does this mean to you:

  • You don’t have to leave Lamprey Health Care to get treatment
  • We can help you get the medications you need
  • You are likely to have lower co-pay costs


What is Hepatitis C?

Hepatitis C is a blood-borne virus primarily affecting the liver. The liver breaks down nutrients, filters blood, and fights infection. Over 95% of people suffering from chronic Hepatitis C can be cured with modern treatment.

Who is at risk for Hepatitis C?

  • Baby Boomers, typically born between 1945-65
  • People who received donated blood, blood products, or whole organs prior to 1992
  • People who have injected drugs, even one time or many years ago
  • Individuals with chronic conditions such as liver disease, HIV or AIDS, or who are on hemodialysis
  • Anyone born to a mother with Hepatitis C
  • Individuals exposed to the blood of someone known to have Hepatitis C

What are the symptoms of Hepatitis C?

Most people do not show signs or symptoms of Hepatitis C infection. If you fall into any of the at-risk categories, you should be tested. Those who do show symptoms may experience fever, fatigue, upset stomach, dark urine, gray-colored stool, joint pain, and/or yellowing of the skin and eyes.

How do I get treatment?

Hepatitis C is easy to treat, although treatment takes several weeks and requires close management. We offer in-house testing and treatment of Hepatitis C for our patients. Treatment and medications vary but usually have few or no side effects. We can manage your treatment and provide case management.

To learn more, talk to your primary care provider.


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No Problem.

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