Better Support.
Better Coordination.
Better Living.
Living with an ongoing medical condition can involve medications, appointments, testing, lifestyle changes, and many moving parts. You shouldn’t have to navigate it alone.
Chronic Care Management (CCM) at The New England Wellness Group provides additional support between regular medical visits, helping you stay connected with your healthcare team and organized around your health goals.
Ask About Chronic Care Management → Explore Program BenefitsWhat Is Chronic Care Management?
Chronic Care Management is a structured approach to helping patients manage ongoing medical conditions over time.
Instead of relying only on periodic office appointments, CCM creates additional opportunities for communication, care planning, follow-through, and coordination.
Your care team may help you review treatment recommendations, identify barriers to progress, organize next steps, and connect with other services when appropriate.
The goal is to make healthcare more connected, understandable, and manageable in everyday life.
How Chronic Care Management Can Help
Effective chronic care involves more than treating symptoms. It includes planning, education, coordination, and ongoing attention to the challenges of daily life.
Personalized Care Planning
Work with your team to understand priorities, review treatment goals, and identify practical next steps.
Medication Support
Discuss medication questions, adherence challenges, refill coordination, and concerns that may need clinician review.
Better Care Coordination
Help organizing referrals, testing, specialist recommendations, and follow-up across your healthcare team.
Health Education & Coaching
Receive practical information to better understand your conditions, treatment recommendations, and self-management strategies.
Lifestyle & Wellness Support
Discuss nutrition, activity, sleep, stress management, and realistic changes that may support your health.
Ongoing Check-Ins
Stay connected between appointments to review progress, discuss barriers, and determine whether additional care is needed.
Conditions That May Benefit From CCM
Chronic Care Management may be appropriate for patients managing multiple ongoing health conditions, especially when treatment requires ongoing monitoring or coordination.
Examples include diabetes, hypertension, cardiovascular disease, chronic respiratory conditions, arthritis, and other long-term medical concerns.
Having one of these conditions does not automatically establish eligibility for a particular insurance-covered CCM program.
Your provider can determine whether care management services are clinically appropriate.
A Partner in Managing Your Health
Your primary care clinician remains central to your medical care. Chronic Care Management adds structured support through appropriate members of the healthcare team.
Depending on your needs, this may involve a nurse, care coordinator, medical assistant, or other qualified clinical team member working under the appropriate care plan.
The team can help identify challenges, communicate concerns, and organize the next steps needed to keep your treatment on track.
Care management is intended to complement—not replace— regular appointments and appropriate medical evaluation.
How Chronic Care Management Works
The process begins with understanding your needs and determining whether CCM is an appropriate part of your care.
Review Eligibility
Your provider reviews your chronic conditions, care needs, and applicable program requirements.
Develop a Care Plan
Your team identifies relevant health goals, medical priorities, and planned support.
Stay Connected
Scheduled or needs-based contact helps address questions, monitor progress, and coordinate care.
Review & Adjust
Your care team reassesses priorities and updates the plan as your health needs change.
Supporting the Goals of Vermont’s Blueprint for Health
The New England Wellness Group participates in Vermont’s Patient-Centered Medical Home approach to primary care.
Vermont’s Blueprint for Health supports coordinated, team-based healthcare through Patient-Centered Medical Homes, Community Health Teams, and community partnerships.
This approach recognizes that managing chronic illness often requires attention to medical treatment, prevention, behavioral health, and the everyday circumstances that influence wellness.
When appropriate, patients may benefit from connections with Community Health Team services or other local resources that complement their medical care.
Explore Vermont’s Blueprint for Health →Support by Phone, Telehealth, or In Person
Chronic care support does not always require another trip to the medical office. The appropriate format depends on your clinical needs and the services being provided.
Telephone Check-Ins
Certain care management activities can be completed remotely, including appropriate discussions about treatment plans, goals, and follow-up.
Telehealth Visits
When clinically appropriate and available, telehealth appointments can provide an additional way to connect with your clinician.
In-Office Care
Physical examinations, certain testing, procedures, and other medical needs may require an in-person appointment.
Formal monthly CCM services are commonly delivered outside regular face-to-face visits. Telehealth medical appointments and billable CCM services are not necessarily the same service.
Insurance and Medicare Coverage
Medicare offers Chronic Care Management benefits for eligible patients with multiple qualifying chronic conditions.
Under Medicare’s traditional CCM eligibility framework, patients generally have at least two chronic conditions expected to last 12 months or longer (or until death) that place them at significant risk of serious health complications or functional decline.
Covered CCM services generally require patient consent, a comprehensive care plan, and other Medicare program requirements.
Medicare Part B cost-sharing may apply. Other insurance plans may have different coverage rules, eligibility requirements, or patient costs.
Please contact our office to discuss whether NEWG currently offers a covered CCM service appropriate to your situation.
Chronic Care Management FAQs
Is CCM the Same as a Regular Office Visit?
No. CCM provides structured care management activities, often between regular appointments. It complements, rather than replaces, necessary medical visits.
Do I Need More Than One Chronic Condition?
Medicare’s traditional CCM benefit generally requires two or more qualifying chronic conditions. Other care coordination programs may use different criteria.
Do I Have to Come Into the Office?
Many CCM activities may be provided remotely. Your clinician may still recommend in-person visits when an examination or other medical service is needed.
Who Will Contact Me?
Care management may involve a nurse, care coordinator, or other qualified team member working with your treating clinician.
Can CCM Help With Medications and Referrals?
Yes. Appropriate care management may include medication-related communication, referral coordination, and help organizing recommended follow-up.
Does Medicare Cover CCM?
Medicare covers qualifying CCM services for eligible beneficiaries. Deductibles and coinsurance may apply. Coverage does not guarantee that every practice offers every service.
Can I Stop Participating?
Participation in Medicare CCM is voluntary. Patients may withdraw consent, subject to applicable program and billing requirements.
How Do I Get Started?
Speak with your NEWG clinician or call our front desk to ask whether Chronic Care Management is available and appropriate for you.
Learn More About Coordinated Chronic Care
These resources provide additional information about Chronic Care Management, Medicare benefits, and Vermont’s approach to coordinated primary care.
Medicare Chronic Care Management
Official Medicare information about CCM eligibility, coverage, and potential patient costs.
Explore Medicare Coverage →Vermont Blueprint for Health
Learn about Vermont’s initiatives supporting preventive care, Patient-Centered Medical Homes, and community-based care coordination.
Visit the Blueprint →Community Health Teams
Learn how Community Health Teams connect patients with additional health, behavioral, and community resources.
Explore Community Health Teams →Ask About Chronic Care Management at NEWG
If managing your health feels complicated, additional support may help. Our team can discuss whether appropriate care management services are available.
Speak With Our Team
Call our office to discuss Chronic Care Management, clinical eligibility, insurance questions, and next steps.
Call 802-267-4838 → Contact Our Office →Already a NEWG Patient?
Established patients may use the secure Patient Portal for appropriate nonurgent communication and available account information. Portal access requires an invitation.
Access Patient Portal →Important Information About Chronic Care Management
Chronic Care Management supplements regular medical care and does not replace necessary appointments, urgent evaluation, or emergency services. Enrollment, covered activities, and patient costs vary by program and insurance plan. Communication through CCM is not intended for emergencies. If you experience a medical emergency, call 911.
You Don’t Have to Manage It All Alone.
At The New England Wellness Group, we believe effective healthcare extends beyond the exam room. Chronic Care Management can help patients stay informed, supported, and connected to their care team.
Ask About Chronic Care Management → Email Our OfficePlease do not include sensitive medical information in ordinary email. Established patients should use the secure Patient Portal for appropriate clinical messages.