Chronic Disease Support

North Hills Family Medicine is a proud member of the Catalyst Health Network, which allows us to maximize our ability to provide you with high quality efficient care and the following added benefits to you with Chronic Disease Support. We have a team of RNs and care coordinators who will work closely with you and your family to help you understand chronic disease states, manage referrals and be the voice for you between your appointments with us.

Car Managers play a fundamental role in Catalyst Health Network’s focus on a value-based care model.  Functioning as an extension of our office, they provide support, education, and assistance in the prevention and/or maintenance of the patient’s condition, health, and wellness.  Care Mangers closely to monitor high risk patients through disease management, collaborating with providers to help overcome barriers to meeting health related goals.

They also aim to reduce hospital readmissions by discussing discharge instructions, completing medication reconciliations, and assisting in follow-up appointment scheduling when completing discharge calls.  Care Managers work in a variety of other ways with patients while also overseeing and working in conjunction with care coordinators.

To sign up for this free service, talk to your provider today.

Continue Reading