Principal Care Management PCM

Principal care management (PCM) specifically relates to a single chronic care condition. For managing a single chronic care condition effectively, healthcare providers often follow evidence-based guidelines and best practices for that condition.

Patients Eligible:

✓ CKD      ✓ ESRD     ✓ HTN

Specialized Kidney Care

PCM in nephrology clinics focuses on comprehensive kidney disease management, by efficiently managing HTN, DM2 and CKD.

Disease Progression Monitoring

PCM enables close monitoring of kidney disease progression, leading to timely interventions and reduced complications.

Patient Education

It emphasizes patient education on kidney health, treatment options, and lifestyle modifications for better self-management.

Care Team Collaboration

PCM fosters collaboration among nephrologists, primary care providers, and specialists, ensuring coordinated and holistic care.

Data-Driven Value-Based Care

PCM in nephrology clinics tailors care plans to the unique needs and preferences of kidney patients, prioritizing their well-being.

Specialized Kidney Care

PCM in nephrology clinics focuses on comprehensive kidney disease management, by efficiently managing HTN, DM2 and CKD.

Disease Progression Monitoring

PCM enables close monitoring of kidney disease progression, leading to timely interventions and reduced complications.

Patient Education

It emphasizes patient education on kidney health, treatment options, and lifestyle modifications for better self-management.

Care Team Collaboration

PCM fosters collaboration among nephrologists, primary care providers, and specialists, ensuring coordinated and holistic care.

Data-Driven Value-Based Care

PCM in nephrology clinics tailors care plans to the unique needs and preferences of kidney patients, prioritizing their well-being.

Remote Patient Monitoring RPM

Remote patient monitoring (RPM) is a form of telehealth where healthcare providers track patients' health using digital medical devices like weight scales, blood pressure monitors, glucometers. This technology enhances healthcare delivery and keeps patients connected to their providers.

Patients eligible:
✓ HTN    ✓ CKD    ✓ DM2

Remote Cellular Enabled devices used:
 ✓ BP monitors
✓ Weigh Scales
✓ Blood glucose monitors

Continuous Kidney Health Tracking

RPM enables ongoing monitoring of kidney function and vital signs, ensuring early detection of issues in nephrology patients.

Proactive Intervention

It allows for timely interventions to manage complications, such as electrolyte imbalances, fluid overload, and blood pressure control.

Enhanced Medication Management

RPM assists in medication adherence and adjustments, crucial for controlling hypertension and diabetes, common comorbidities in nephrology patients.

Improved Access to Care

Patients benefit from real-time communication with their care team, reducing the need for frequent in-person visits.

Quality of Life Enhancement

RPM promotes better quality of life by minimizing the burden of ER visits and hospitalization, and enhancing patient engagement in their kidney health management.

Remote Patient Monitoring RPM

Continuous Kidney Health Tracking

RPM enables ongoing monitoring of kidney function and vital signs, ensuring early detection of issues in nephrology patients.

Proactive Intervention

It allows for timely interventions to manage complications, such as electrolyte imbalances, fluid overload, and blood pressure control.

Enhanced Medication Management

RPM assists in medication adherence and adjustments, crucial for controlling hypertension and diabetes, common comorbidities in nephrology patients.

Improved Access to Care

Patients benefit from real-time communication with their care team, reducing the need for frequent in-person visits.

Quality of Life Enhancement

RPM promotes better quality of life by minimizing the burden of ER visits and hospitalization, and enhancing patient engagement in their kidney health management.

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