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Ongoing Management & Follow-Through

Chronic Care Management

Board-certified virtual management for diabetes, hypertension, thyroid disease, high cholesterol, and other long-term conditions. Lab monitoring, medication adjustment, and the kind of follow-through that keeps small problems from becoming big ones.

Board-Certified HIPAA-Compliant $68 Self-Pay DE · MD · WA
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What Is Chronic Care Management?

Chronic care management is the ongoing clinical work of keeping long-term conditions stable and complications at bay — checking labs at the right intervals, adjusting medications when numbers drift, catching side effects early, and helping you make the lifestyle changes that actually move the needle. It is the unglamorous, longitudinal medicine that prevents heart attacks, kidney failure, and avoidable hospitalizations.

At Innocre Telehealth, chronic care lives at the center of what we do. Our care model is specifically designed for it: 30-minute default visits, a dedicated care coordinator who follows up on labs and pending referrals, and proactive outreach when a result needs attention. We work with patients who have an established diagnosis and are willing to engage in monitoring — labs through Quest or LabCorp, home blood pressure or glucose readings, and regular follow-up cadence.

At $68 for self-pay patients, ongoing visits are designed to be financially sustainable. We coordinate actively with your specialists (cardiology, endocrinology, nephrology) when you have them.

Conditions We Manage

Best fit for patients with established diagnoses who need ongoing medication and lab management. New, complex, or unstable presentations may need an in-person specialist evaluation first.

Cardiometabolic

Hypertension (high blood pressure)
Type 2 diabetes & pre-diabetes
High cholesterol & statin management
Cardiovascular risk-factor reduction

Endocrine & Bone

Hypothyroidism & thyroid replacement
Vitamin deficiencies (D, B12, iron)
Osteoporosis monitoring & bisphosphonate management

GI & Respiratory

GERD & chronic acid reflux
Mild-to-moderate asthma maintenance
Allergic rhinitis & chronic allergies

Other Stable Conditions

Stable depression & anxiety (non-controlled meds)
Migraine prophylaxis — topiramate, propranolol, amitriptyline, gepants (Aimovig, Emgality, Ajovy, Qulipta). Excludes butalbital combinations and any opioid analgesics.

Managing a chronic condition? Let's set you up with consistent follow-through.

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How Ongoing Care Works

1

Initial Visit

30-minute baseline review of diagnoses, current medications, recent labs, and goals.

2

Labs Ordered

Quest or LabCorp requisition sent to a draw site near you. Results sent directly to your portal.

3

Adjust & Coordinate

Medication titration, lifestyle counseling, and care coordination with specialists.

4

Proactive Follow-Up

Care coordinator monitors for overdue labs, missed refills, and trends needing attention.

When You Need More Than Telehealth

Some chronic conditions are better managed in-person or by sub-specialists. We will tell you when you fall into one of these categories and refer accordingly:

  • Type 1 diabetes & insulin pump management — endocrinology preferred
  • Heart failure, recent MI, severe arrhythmia — cardiology required
  • Advanced CKD or dialysis — nephrology
  • Active rheumatologic disease on biologics — rheumatology
  • Cancer treatment & survivorship — oncology
  • Conditions requiring controlled medications — opioids, benzodiazepines, ADHD stimulants
  • Conditions requiring frequent in-person physical exam — for example, severe COPD requiring lung-sound monitoring

Frequently Asked Questions

Most stable chronic conditions are seen every 3–6 months, with labs at intervals appropriate to the diagnosis (for example, A1C every 3 months for diabetes that is not yet at target and every 6 months once stable, lipid panel annually if on a stable statin). Newly-adjusted medications usually need a 4–6 week follow-up. Your provider will set the cadence based on what your specific conditions and medications require.
We send a lab requisition electronically to Quest Diagnostics or LabCorp, and you go to whichever draw site is most convenient — most patients have one within a few miles of home or work. Results come back to us in 24–72 hours, and we review them with you at your follow-up visit or via secure portal message if action is needed sooner. No insurance friction; cash-pay lab pricing is typically a fraction of insurance-billed pricing.
Yes — actively. Most chronic care is multi-specialty, and care fragmentation is one of the biggest reasons patients fall through the cracks. We send visit summaries to your specialists, send referrals when something is outside our scope, and collect their notes back so we can coordinate medication changes and avoid duplicating or contradicting care.
For hypertension management, yes — home blood pressure readings are the gold standard for guiding treatment. We ask patients to bring at least one full week of readings (2 morning and 2 evening readings for 7 consecutive days, ≈14 readings minimum) so we can compute a reliable average instead of relying on single in-office numbers. For diabetes, home glucose monitoring or a continuous glucose monitor (CGM) is similarly important. We can recommend reliable home devices, walk you through technique, and interpret your readings clinically.
We frequently make new diagnoses for straightforward conditions (hypertension, hyperlipidemia, hypothyroidism, mild asthma, allergic rhinitis) when history, labs, and home readings allow it. More complex new diagnoses — particularly type 1 diabetes, heart failure, autoimmune disease, or anything requiring imaging or hands-on examination — are best evaluated in-person initially. We refer when that is the right call.
Innocre Telehealth is currently licensed to see patients located in Delaware (DE), Maryland (MD), and Washington (WA) at the time of their visit. You must be physically present in one of these three states during your appointment.
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Care That Follows Through

Labs ordered, results reviewed, refills sent, specialists looped in. No falling through the cracks.

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Serving DE · MD · WA  |  HIPAA-Compliant  |  Board-Certified Provider