Chronic Care Management for Kidney Disease
Ongoing Kidney Disease Support Through Chronic Care Management
At Kidney Specialists of Central Oklahoma (KSCO), we understand that managing complex, chronic conditions requires support that extends beyond your scheduled appointments. That's why we've partnered with Tellihealth to offer a comprehensive Chronic Care Management (CCM) program for eligible patients living with Chronic Kidney Disease (CKD) and other ongoing kidney conditions.
How Our Chronic Care Management Program Works
Through our partnership with Tellihealth, Chronic Care Management gives you ongoing access to a dedicated care team that keeps you connected, informed, and supported between clinic visits. Here's how it works:
- You'll be assigned a dedicated care coordinator who gets to know your health goals and history
- Your care team creates and maintains a personalized care plan tailored to your conditions
- Proactive outreach keeps you on track with medications, follow-ups, and preventive care
- Your KSCO providers stay informed in real time, allowing for faster responses to changes in your health
This coordinated, continuous approach helps identify and address concerns before they escalate, reducing your risk of avoidable hospitalizations and emergency visits.
Benefits of Chronic Care Management
- Coordinated care across all your providers and specialists
- Reduced risk of complications from CKD and related chronic conditions
- Fewer hospitalizations and emergency room visits
- Ongoing support from a dedicated care coordinator
- A personalized care plan that reflects your individual health goals
Covered by Most Insurance Plans
Our Chronic Care Management program is available at little or no cost for many patients, depending on your insurance plan. Medicare covers CCM services, making this program accessible to a large portion of our patient population.
Why Chronic Care Management Matters for CKD Patients
Chronic Kidney Disease rarely occurs in isolation. Most patients managing CKD are also living with conditions like hypertension, diabetes, heart disease, or anemia, requiring careful coordination across multiple areas of care. Without consistent follow-up and support between visits, small changes can quickly turn into serious complications.
Studies show that patients enrolled in structured Chronic Care Management programs experience better medication adherence, improved lab values, and significantly lower rates of hospitalization compared to those receiving standard care alone.
CCM bridges the gap between your office visits by ensuring that your care team is always engaged, your care plan stays current, and you have someone to call when questions arise.
Sources: BMC Nephrology — CKD Comorbidity Study | CMS Chronic Care Management Evaluation | Avalere Health — CCM in Medicare
Provided in Partnership with
Fewer Complications Start with Consistent Care
Managing Chronic Kidney Disease and other complex conditions is an ongoing process. With Chronic Care Management, you and your KSCO care team stay connected, coordinated, and ahead of potential health risks. Call us at 405-942-5442 or Request an Appointment Online to find out if you qualify for this program and start receiving personalized support.
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