- Chronic Care Management
Discover Our Comprehensive Chronic Care Management Services
Horizon offers comprehensive chronic care management with a focus on personalized service. Our chronic care management services are available in various regions including Boise/Meridian and Mountain Home.
- Chronic Care Staff
Effective Chronic Care Management
Our chronic care management service is designed for patients discharged from hospitals or sub-acute rehab facilities with chronic conditions that increase their risk of hospitalization. We provide compassionate follow-up care soon after discharge, working closely with home health teams to support rehabilitation and ensure continuity of care. By closely monitoring our patients and collaborating with specialists, we strive to stabilize their health quickly, reduce Medicare expenses, and prevent unnecessary hospital visits.
Our team of dedicated professionals ensures comprehensive care for patients managing chronic conditions:
- Registered Nurses (RNs)
- Nurse Practitioners (NPs)
- Care Coordinators
- Pharmacists
- Dietians
- Social Workers
- Social Workers
- Therapists (Physical, Occupational, Speech)
- Caregiver Support
- Service Areas
Where Do We Offer Chronic Care Management?
We offer professional and compassionate Chronic Care Management services throughout Idaho. If we cover your area, reach out to us! Let’s see how we can improve the quality of life for you or your family member.
We provide Chronic Care Management services in Boise/Meridian and Mountain Home.
- Roadmap To Hospice Care
A Personalized Plan That Works For You
Each person who works for Horizon Home Health & Hospice provides important and necessary skills that help promote your well-being. Our team of quality nurses, aides, therapists, and allied healthcare professionals, all serve a vital role on our team. As we work together with your physician, our strategy is to develop a plan of care that will maximize your independence and quality of life. Each plan is unique and each patient’s success is measured and celebrated.
Teamwork Means Success
We also know it takes a team to be successful. Each member of the team shares responsibility and contributes to the treatment plan to assure the highest quality of services are delivered with compassion and respect.
Your Physician
Oversees your treatments and the members of your unique care team.
Our Team
Our nurses, therapists, and aides help to implement treatments and collaborate to meet your goals of recovery.
The Patient
Collaborators and supports for health management and recovery goals.
Family & Caregivers
Collaborators and supports for health management and recovery goals.
- Plan Of Action
Is Chronic Care Management Right For You?
Recognizing the signs that chronic care management may be beneficial can lead to improved health outcomes and quality of life. Here are a few signs that you or a loved one may be in need of chronic care management services from Horizon.
Frequent Hospitalizations For Chronic Conditions
Difficulty Managing Multiple Medications
Challenges Controlling Symptoms Of Chronic Illness
Limited Mobility Or Activities Due To Health Issues
Recent Discharge With Ongoing Health Needs
Coordination Struggles Among Healthcare Providers
Increased Need For Medical Attention
Caregiver Burnout Due To Ongoing Care Needs
Progression Of Chronic Conditions Requiring More Support
- More Services
Learn About Additional Services We Offer
Looking for something different? Learn more about our other life-changing services.

Home Health
Home Health focuses on recovery and rehabilitation. Home Health refers to a wide range of medical services provided at a patient's home to help them recover from an illness, surgery, or manage chronic conditions.

Hospice Care
Hospice care, when administered at the optimal juncture, offers patients the invaluable gift of time. It affords them the opportunity to come to terms with their diagnosis, relish moments of nostalgia, bid their farewells, and put their affairs in order.

Palliative Care
Palliative care is specialized medical care that focuses on providing relief from the symptoms, pain, and stress of a serious illness, regardless of the diagnosis or stage of the disease.

Wound Care
Comprehensive wound care services aimed at promoting healing and recovery, with personalized treatment plans tailored to meet each patient's specific needs.
- FAQ
Frequently Asked Questions: Chronic Care Management
Curious about Chronic Care Management? Discover how it can benefit you or a loved one managing chronic conditions. Get answers to your questions here.
What is Chronic Care Management?
Chronic care management involves coordinated healthcare services for patients with chronic conditions to improve health outcomes and quality of life.
Who can benefit from Chronic Care Management?
Individuals with chronic conditions such as diabetes, heart disease, or COPD who require ongoing medical attention and support.
What services are included in Chronic Care Management?
Services may include regular care coordination, medication management, monitoring of vital signs, and patient education on self-management.
How does Chronic Care Management reduce hospital readmissions?
By closely monitoring patients’ health, managing medications, and addressing symptoms promptly, chronic care management helps prevent complications that lead to hospital visits.
How often do patients receive Chronic Care Management services?
Services vary based on patient needs but typically include regular check-ins, personalized care plans, and access to healthcare providers as needed.
Is Chronic Care Management covered by insurance?
Yes, Medicare and many private insurance plans cover chronic care management services when medically necessary.
How do I enroll in Chronic Care Management services?
Speak with your healthcare provider to see if you qualify for chronic care management. They can help you enroll and explain the services available to you.
What are the benefits of Chronic Care Management?
Benefits include improved disease management, enhanced quality of life, reduced healthcare costs, and better overall health outcomes.
Can Chronic Care Management help with chronic pain management?
Yes, chronic care management often includes strategies for managing chronic pain through medication, therapy, and lifestyle adjustments.
How does Chronic Care Management support patient empowerment?
By providing education, tools, and resources, chronic care management empowers patients to actively participate in their own care and make informed decisions about their health.
