Chronic Condition Health Home (CCHH)
What is a Chronic Condition Health Home?
A chronic condition health home (CCHH) targets members with at least two chronic conditions: hypertension, heart disease, diabetes, asthma, substance abuse, mental health or being overweight. A member may have only one chronic condition but be at risk of getting another to participate in a CCHH. A CCHH engages these members in their healthcare and coordinates their care to improve health outcomes. A CCHH provides primary care delivered through a patient-centered medical home (PCMH) model.
Helpful Documents
- CCHH Person-Centered Care Plan (PDF)
- Comprehensive Assessment and Social History (PDF)
- Chronic Condition Health Home Notification Form (PDF)External Link
- Chronic Condition Health Home Notification Form Guide (PDF)External Link
- Patient Tier Assignment Tool (PTAT) (PDF)External Link
- Patient Tier Assignment Tool Guide (PDF)External Link