What to Expect from Chronic Care Management for Diabetes


If you’re living with diabetes, you’re in good company. Researchers report about 11% of American adults have been diagnosed with diabetes, and many more are living with insulin resistance, prediabetes, or undiagnosed diabetes.

When you have diabetes, getting medical care is a must. At Prima Medicine, in Fairfax and South Riding, Virginia, our board-certified providers offer personalized diabetes care with customized treatment plans, so you can enjoy optimal health.

Our team also recommends joining our chronic care management (CCM) plan if you have a chronic health condition, such as diabetes. This unique program gives you access to user-friendly tools and resources, 24/7 care access, use of our designated CCM phone line, and a dedicated CCM care coordinator.

Keep reading to learn more about CCM and how it can help you better manage your diabetes.  

CCM: An overview

When you have a chronic health condition, it’s normal to have multiple providers and specialists overseeing your care. For example, besides your primary care team, your diabetes team may include an endocrinologist, podiatrist, neurologist, eye doctor, dietitian, dentist, mental health provider, and others.

And while all of these care providers can be very helpful, the problem is that they may be unaware of what the other providers are doing. For example, a specialist provider may not know about a new medication you’re taking or the impact a different prescription can have on your condition.

This is where chronic care management comes in. With CCM, your dedicated care coordinator works with your entire care team to make sure you receive the best overall and diabetic care possible. This includes liaising with different providers in addition to your Prima Medicine team, such as:

  • Social workers
  • Resource care providers
  • Physical therapists
  • Alternative care providers, such as a therapeutic masseuse
  • Diabetes specialists, such as endocrinologists or podiatrists
  • Surgeons and surgical care teams


Your CCM coordinator approaches your condition holistically. This means they look beyond your disease to assess your habits, diet, lifestyle, environment, work, stress, and more to make sure nothing affecting your health gets overlooked. 

What to expect from CCM for diabetes

To get started with Prima Medicine’s CCM program for diabetes, begin by making an appointment with one of our providers. Your team member assesses your overall health and the condition of your diabetes to ensure you’re eligible for enrollment in CCM.  

Once you’re a part of our CCM care program, you can expect the following:

Regular check-ins with your CCM provider 

One of our patients’ favorite things about being a part of the CCM program is that you don’t have to remember to call your provider with health updates and check-ins. Your CCM coordinator calls you 1-2 times each month.

During these calls, you can expect questions about changes in your health, medical plan, or general lifestyle. You can raise questions or concerns about your condition, and your CCM coordinator brings them to your team’s attention. 

Most CCM patients are highly satisfied with this extra care and attention, as it helps improve their health without putting additional tasks on their to-do list.   

Access to providers 24/7

When you have diabetes, you can’t always predict when you’ll need immediate care or attention. Frequently, issues arise outside of regular business hours. But with CCM, you can reach your health care provider regardless of when a diabetic health care question arises. 

As part of Prima Medicine’s CCM program, you have 24/7 access to your CCM provider. Depending on the situation, they may help you get in touch with a specialist or refer you to the primary care provider on call. 

And since diabetes is a complex chronic disease, we also offer remote patient monitoring (RPM). This system sends alerts about your health even when you’re asleep, so if your blood sugar surges or drops, we can get you the care you need. 

Reduced financial burden

Research shows that when diabetes patients enroll in CCM programs, their overall annual health expenses decrease. There are several reasons for these savings, including:

  • Fewer trips to primary care/specialty providers for routine questions
  • Help achieving health goals without expensive treatments
  • Fewer trips to the ER and less frequent hospitalizations
  • Assistance in locating lower-priced medications and therapies

In addition, many private and public health insurance groups — including Medicare — cover CCM care programs, making it an affordable option. 

To learn more about CCM and what to expect from the program, book an appointment online or over the phone with Prima Medicine today.

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