Chronic Care & Remote Monitoring
Care between visits — monitored readings, medication changes by phone, and a monthly check-in with your family.
Most of what happens to a long-term condition happens between appointments. Chronic care management and remote monitoring close that gap: your readings reach us as they are taken, we adjust medication by phone rather than waiting for your next visit, and someone from the practice speaks to you or your family every month. Dr. Katari recommends it to every patient who qualifies.
Who it is for
The program is built around the conditions where small changes between visits matter most. If you live with one or more of these, ask us whether you qualify.
- High blood pressure
- Diabetes, type 1 or type 2
- Congestive heart failure
- An irregular heart rate, including atrial fibrillation
- A previous heart attack
They are two different things
Chronic care is the contact between visits. If you live with something like high blood pressure or diabetes, it is a phone conversation where we go through how you are doing and adjust medication without waiting for your next appointment.
Remote monitoring is the equipment. A blood pressure cuff, and a glucose meter where that applies, sending readings through as they are taken so we can see what is actually happening rather than the one number we get on the day you come in.
Most people benefit from both, and they are usually enrolled together. One tells us there is a problem; the other lets us do something about it.
How it works
- You are given a monitor — most often a blood pressure cuff, and a glucose meter where that applies.
- Your readings come through to the practice as they are taken, so we see the trend rather than a single number on the day of your appointment.
- If something needs changing, we adjust your medication over the phone instead of waiting for the next visit.
- You or a family member hear from us every month, whether or not anything is wrong.
- If a reading suggests something urgent, we call you.
What it can and cannot do
The honest version, in Dr. Katari's words: this does not change how long you live. In Medicare's own evaluations of chronic care management, enrolled patients ended up in hospital less often — individual results vary, and how early we catch a problem that would otherwise have been found late.
Readings taken at home also give us something a single office visit cannot — what your blood pressure or glucose actually does across a month, at the times of day you really live in. That is usually a more useful picture than the number we get in the clinic.
For residents in assisted and independent living
We strongly recommend this for every resident in assisted or independent living. Residents are seen on a scheduled visit every couple of weeks rather than whenever something changes, and monitoring covers the days in between.
It also changes how families hear from us: a call every month as a matter of course, rather than only when something has gone wrong. Over time it tends to reduce hospital admissions, and often the number of medications a resident is taking as well.
What we offer
- Practice-supplied blood pressure and glucose monitoring
- Medication adjustments by phone between visits
- A monthly check-in with you or your family
- Readings reviewed by Dr. Katari's practice, not an outside call centre
- Coordinated with your regular visits, not a replacement for them
Common questions
Does it replace my regular appointments?
No. It sits alongside them. You still come in for your visits — monitoring covers the weeks in between, and it usually makes those visits more useful because we arrive with a month of readings rather than one. Because we already know your condition and see your readings, some issues can be evaluated by phone or tele-visit between appointments — Dr. Katari decides case by case, and new infections usually still need an exam or a rapid test first.
Is it covered by my insurance?
Chronic care management and remote monitoring are recognized Medicare benefits and are covered by many commercial plans, but the details — including whether you have a copay — depend on your plan. We check your coverage and tell you what it will cost before you enroll, never after.
Do I need to be good with technology?
No. The monitor is set up for you and sends its readings on its own. If you can take your own blood pressure, you can use it. Family members and community staff can help, and often do.
What happens if a reading looks wrong?
We call you. That is the point of it — a number that would otherwise have sat unseen until your next appointment gets looked at while there is still time to do something simple about it.
Can I stop?
Yes, at any time. Tell us and we will unenrol you and arrange collection of the monitor.
Related care
Ready to see a doctor who listens?
Book online in a couple of minutes, or call and our staff will help you find a time.