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Chronic Care Management at Phillips County Health Systems is a service that fully embraces our mission, "Patient-centered excellence."
For more information, Call: (785) 540-4939

Chronic Care Management

Our goal for Chronic Care Management is to help patients manage their chronic conditions by maintaining consistent communication, following patient health needs, preventing health crises and hospitalizations, and improving quality of life.


  • Ensure continuance of healthcare

  • Assessment of your medical needs

  • Oversight of your medication self-management

  • Coordination of recommended preventive care services

  • Enhanced opportunities for communication with your healthcare provider

  • Coordination of care with home and community-based clinical service providers

What to expect:​

  • Monthly phone calls with your care coordinator

  • An individualized plan of care

  • 24/7 phone access to healthcare professionals to assist with urgent needs

Who Qualifies?​

For individuals with 2 or more chronic conditions, these include but are not limited to:

  • Alzheimer’s disease and related dementia

  • Arthritis (osteoarthritis and rheumatoid)

  • Asthma

  • Atrial fibrillation

  • Autism spectrum disorders

  • Cancer

  • Cardiovascular Disease

  • Chronic Obstructive Pulmonary Disease

  • Depression

  • Diabetes

  • Hypertension


Care Coordinator
Jamie Baker, RN, BSN

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