Chronic Disease Management
One of Mountain Family’s goals is to optimize chronic disease control, which results in improved wellness and fewer complications from uncontrolled chronic disease. We deploy a team-based hands on approach that encompasses a proactive risk stratification (based on medical history, biometrics, and care utilization patterns) and subsequent development of individualized, comprehensive care plans. We identify chronically ill patients, so our care team can target interventions and intensively manage and coach these patients. Services include but are not limited to:
Respiratory problems (COPD/asthma)
High blood pressure
Medical management of behavioral health issues (depression, anxiety, PTSD)
Goals of care
Behavioral Health Services
Mountain Family offers integrated behavioral health services at all our clinics. Access to a licensed therapist is often available during routine medical care for case management.