Care Management for Osteoarthritis

What the program is

Osteoarthritis is the gradual wearing down of the cartilage that cushions the ends of the bones in a joint, which can lead to pain, stiffness and swelling. It is a long-term condition, and how you feel can change from month to month with activity, weight, other health conditions and treatment.

Principal Care Management is a Medicare-covered service for people who have one serious long-term condition that needs ongoing attention. In our program, that condition is osteoarthritis. The goal is to keep track of how you are doing between office visits, adjust your plan when something changes, and notice changes sooner.

How it works

• Each month, a physician assistant (PA) or nurse practitioner (NP) from our practice calls you at a time that works for you.
• On the call you can talk about your joint symptoms, your other health conditions, your goals, any risks such as falls, and any changes in your medical status.
• Together you build and update an individualized care plan based on your symptoms, lifestyle and goals.
• After each call, your physician receives a progress note so they can follow your health between appointments. The information becomes part of your medical record.
• The calls take place from home and do not require any extra office visits. Your regular in-office appointments stay the same.
• These calls come from our own care team. They are not related to calls you may receive from your insurance company.

Benefits

The program is meant to make it easier to keep up with osteoarthritis without adding trips to the office:

• Regular check-ins, so your care plan can be adjusted between visits instead of waiting months.
• Collaborative care. The PAs and NPs who call you work in the same office as your physician, and your physician sees their notes.
• Convenience. Calls happen by phone, from home, on a schedule that suits you.
• A clear plan. You have a written, individualized plan and a regular chance to ask questions about it.

Your plan may include home exercise, weight and activity goals, physical therapy in our office, fall prevention, bracing, medication questions for your physician, or discussion of injections or other treatment at your next visit.

Who is eligible

The program is for Medicare patients with osteoarthritis who are cared for by our practice. Ask our team whether you qualify and how the program fits with your current treatment.

Principal Care Management is a Medicare-covered service, but your plan's usual cost sharing may apply. Our staff can explain what that means for your coverage before you enroll.

How to enroll

Ask about care management at your next visit, or call our office and ask to speak with someone about the care management program. We will confirm that you are eligible, review any cost sharing with you, and set up your first monthly call.

Frequently Asked Questions