Chronic Care Management Helping You Manage Your Healthcare Needs at All Stages of Adult Life. We take a compassionate, patient-centered approach to chronic care by partnering with our patients to develop treatment and prevention plans designed to meet their healthcare needs and lifestyle goals. Our experienced team includes certified care managers and coordinators and specially trained nurse practitioners, registered nurses (RNs) and licensed practical nurses (LPNs). Chronic Care Management Case Management and Care Coordination Diabetic Monitoring Program Elevated Blood Pressure Program Home Visits for SOFHA Patients Medicare Chronic Care Management (CCM) Program Senior Services Social Work Program