Managing complex and chronic healthcare conditions can be extremely complicated for patients and their caregivers. CHI is addressing that with a comprehensive care management program that helps patients, families, and healthcare providers navigate care, manage complex health issues, and locate community resources. CHI has a team of dedicated nurse care managers who work within our healthcare community — in Patient-Centered Medical Homes, Community Hospital of the Monterey Peninsula’s emergency department and inpatient floors, and with Aspire’s Medicare Advantage patients.

Care Managers:
–  Enhance the quality of the patient’s healthcare experience
–  Facilitate effective transitions as patients go between health settings and home
–  Provide clinical best practices and patient-centric care plans to help patients reach their wellness goals
–  Educate patients, families, and caregivers about proper healthcondition and medication management
–  Assist patients and providers in reducing unnecessary costs
–  Support patients with community resources
–  Reduce readmissions to the hospital and emergency room

Community Health Innovations | Care Management and Care Coordination