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Why us

We help identify and address your patients' health concerns before they become emergency room visits.

Keep Your Patients Healthier—And Out of the Emergency Room

Our Chronic Care Management (CCM) program helps your practice identify and address patient health concerns before they become medical emergencies.

Through monthly care coordination, medication reviews, symptom monitoring, and ongoing patient education, our experienced care team detects potential issues early and works with your providers to intervene before conditions worsen.

The result is fewer unnecessary emergency room visits, fewer hospital readmissions, improved patient outcomes, and stronger continuity of care—all while generating additional Medicare reimbursement for your practice.

Built Around The Work CCM Requires

Real clinical staff do the recurring work

CCP is not just software. Licensed clinical staff handle recurring outreach, care coordination, monitoring support, and documentation. Patients hear from people who are there to support the care plan. The broader model also includes access to an on-staff pharmacist for medication therapy support.

The monthly work is handled with structure

Care management only works when the monthly work actually gets done. Patient lists have to be maintained. Consent has to be documented. Outreach has to happen. Questions have to be answered. Time has to be tracked. Records have to stay organized. CCP is built around that routine.

CCM Work We Help Manage

Patient Identification

Reviewing which Medicare patients may qualify for CCM, with RPM and MTM support as part of the broader model when appropriate.

Patient Consent

Explaining the program in plain language, helping document consent, and making sure patients know what support they are agreeing to.

Recurring Clinical Work

Delivering recurring outreach, care coordination, monitoring support, and medication-related follow-up.

Device Setup

Supporting RPM device setup and patient education when RPM is part of the program.

Audit-Ready Records

Keeping documentation, time tracking, and archived records organized so the billing workflow has support behind it.

Billing Support

Supporting coding and claims submission so the practice is not left to piece the process together alone.

24/7 Availability

Providing 24/7 portal support for CCM patients while the practice remains central to the care plan.

Compliance is part of the service

These programs are regulated. They should not be run casually. CCP's model includes documented consent, organized records, time tracking, and HIPAA-compliant handling of information. Cost should also be explained honestly. CCM can include the standard Medicare Part B coinsurance. It should not be sold as universally free.

Patients can opt out. Practices keep clinical judgment. CCP supports the care plan. It is there to help the practice deliver better follow-through between visits without weak documentation or confusing handoffs.

Leadership

CCP's credibility rests on real Medicare care-management, billing, and compliance experience. Patients and practices should be able to see who is behind the program.

  • Leadership: Edgar Reyna, MD
  • Leadership: Eunice Zamora, Co-Founder