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Chronic Care Management

Ongoing management program for patients with chronic conditions

Complexity: Complex | Duration: ongoing | Category: Industry/Healthcare

Tags: chronic-care ccm disease-management healthcare

Workflow Diagram​

Steps​

Step 1: Enroll patient​

Agent: care

coordinator - Register in CCM program

Step 2: Conduct assessment​

Agent: clinical

specialist - Comprehensive health evaluation

Step 3: Create care plan​

Agent: clinical

specialist - Develop management strategy

Step 4: Schedule check​

Agent: ins

scheduling-agent - Regular monitoring appointments

Step 5: Track metrics​

Agent: healthcare

specialist - Monitor vital signs and labs

Step 6: Coordinate specialists​

Agent: care

coordinator - Manage multi-provider care

Step 7: Monthly review​

Agent: clinical

specialist - Evaluate progress and adjust

Step 8: Document time​

Agent: revenue

specialist - Track CCM billing minutes

Usage​

To execute this workflow:

/workflow industry/healthcare/chronic-care-management.workflow

See other workflows in this category for related automation patterns.