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Principal Care Management

Principal Care Management is a program started by the Center for Medicare and Medicaid Services to encourage medical practices to identify patients with chronic or high risk conditions, in order to proactively manage their care between appointments.

The Urology Group providers recognize the value this program brings to our patients in maintaining overall health. This program provides eligible patients with a dedicated Care Coordinator to work with them and their provider to develop a comprehensive, individualized plan of care. Consistent timely communication between the patient, their Urology Group provider and their care team allows the Care Coordinator to follow through on the patient’s needs.

Who is eligible for Principal Care Management?

You are eligible for the Principal Care Management program if you have Medicare Part B or a Medicare Replacement Plan and have one qualifying health condition.

A member of our Care Management team will reach out to you by phone. If you choose to participate in this program, you will be assigned to one of our Care Coordinators. Your Care Coordinators will arrange a regularly scheduled phone call. Many patients sign up for a monthly phone call. However, you can choose your call schedule – monthly, every other month, every third month or every six months. Your schedule can be easily adjusted based on your needs or changes in your health.

What are the benefits of the Principal Care Management?

This program provides you with a dedicated Care Coordinator to work with you and your provider in developing a comprehensive, individualized plan of care.

Your personal Care Coordinator will focus on creating better care coordination to improve outcomes and reduce unnecessary ER visits, hospital visits and hospital readmission.

Care Coordinators assess your current condition, answer questions about your treatment plan, review medications and assist with pharmacy coordination.

Care Coordinators schedule appointments and communicate with your primary care provider, work toward quality of life goals and connect you with support services as needed.

Your Care Coordinator will arrange any additional consultations, diagnostic tests and follow-up appointments as advised by your provider.

What are chronic and high risk conditions?

The Centers for Disease Control and Prevention define a chronic condition as any condition that has been ongoing for more than one year and requires prolonged medical care. Chronic conditions are also defined as those that limit the patient’s ability to perform basic activities of daily living. Activities of daily living include eating (feeding themselves), bathing, dressing, toileting (the ability to independently use the toilet and perform personal hygiene), transferring (the ability to independently get in and out of a bed or chair), and the ability to maintain continence (bladder and bowel control).

Urologic chronic conditions

  • Benign Prostatic Hyperplasia (BPH or enlarged prostate)
  • Overactive bladder
  • Recurrent urinary tract infection
  • Bladder cancer
  • Renal cancer (kidney cancer)
  • Prostate cancer
  • Ureter cancer
  • Renal pelvis cancer

CMS list of chronic and high risk conditions (including but not limited to):

  • Alzheimer’s disease/Dementia
  • Arthritis
  • Asthma
  • Atrial fibrillation
  • Autism Spectrum Disorders
  • Cancer
  • Chronic kidney disease
  • Chronic obstructive pulmonary disease (COPD)
  • Depression
  • Diabetes
  • Heart failure
  • Hepatitis (Viral B & C)
  • Hyperlipidemia (high cholesterol)
  • Hypertension (high blood pressure)
  • Ischemic heart disease (coronary artery disease) – reduced blood flow due to plaque build-up in the arteries
  • Osteoporosis
  • Schizophrenia and other psychotic disorders
  • Stroke

Am I eligible for Principal Care Management?

Prinicipal Care Management is covered under your Medicare benefits and could be covered in full if you have secondary insurance. Full coverage depends on your secondary insurance carrier or Medicare Replacement Plan Coverage. Like all other healthcare services, Principal Care Management is subject to your annual insurance deductible, coinsurance, and copay. Depending on your specific benefits there may be a minimal fee associated with the program.

Call our office at (703) 724-1195 and select Care Management or call our Principal Care Management team directly at (703) 936-2922 to learn more and to enroll in our Principal Care Management program.

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