Chronic Care Management in Wisconsin

Vibrant Health Chronic Care Management

The Vibrant Health Family Clinics Chronic Care Management Program is founded on the belief that patients who enroll will experience personalized healthcare that is customized to meet your needs.


Chronic Care Management is a way we add value and provide total care for – and empower – our patients. It is an approach to providing total health care that includes health care professionals, trusted friends or family members (if you wish) and – most importantly – YOU.

Examples of chronic conditions include, but are not limited to, the following:

  • Alzheimer’s disease and related dementia
  • Asthma
  • Atrial fibrillation
  • Cancer
  • Chronic Kidney Disease
  • Chronic Obstructive Pulmonary Disease
  • Depression
  • Diabetes
  • Heart failure
  • Hypertension
  • Ischemic heart disease

*If you have two chronic conditions, you may qualify for this program. Speak to your Healthcare Provider to enroll.

CCM grid


Your Care Coordinator is a team member who specializes in helping you and your family manage your chronic disease. They work with you to coordinate your care, provide education regarding your illness, and help you and your Health Care Provider recognize when a change in treatment is needed.

Your Care Coordinator is here to help as much or as little as you want. They will be able to point you in the right direction so that you can find information and community resources that can help you solve your specific problems. Your Care Coordinator is the one to talk to about how your Health Care Team can better support you in becoming and staying healthy.


  • Work with you until your goals are met
  • Be a personal point of contact between you and your Healthcare Provider
  • Have direct phone access to your care
  • Assist with medication management and education
  • Become a member of your Healthcare team to ensure treatments and services are being completed to improve overall health and wellbeing.
  • Create a care plan that incorporate specific, short- term goals and necessary actions to achieve those goals
  • Provide patient education and resources on chronic diseases and prevention
  • Help you find community resources
  • Assist with finding cost effective medications


As the caregiver to my sick dad, I worked with the Care Coordinators through the Chronic Care Management program to help my dad locate the community resources he needed to help him get better.


I live by myself and I feel like I have a safety net with the care coordinators. I can call them anytime to get my questions answered. The Chronic Care Management Program is a million dollar idea. I love it. ~ Allegra

The Chronic Care Management connected me to a dietician to help with nutrition and label reading. They also worked with my cardiac rehab unit to make sure I made it to my appointments to strengthen my heart. ~Calla

I was very sick. It was such a struggle, but the compassion and listening skills of my care team helped me become self-sufficient.