Advanced Primary Care
One Health
Advanced Primary Care
Advanced Primary Care
One Health is excited to offer Advanced Primary Care Program services to all One Health patients. The goal of the program is to identify and improve the health outcomes of high-risk patients with multiple chronic conditions who have been admitted or are at risk of being admitted to the hospital. Our transitional care program manages patients after they are discharged from the hospital and connects them with the resources needed to safely transition to their home setting. Our transition program and team are dedicated to keeping you healthy and at home.
Services Offered
Enhanced access and close follow up weekly as needed with a Physician or APP. Our visits are scheduled with more time to address all concerns and provide disease specific education and additional support services you may need.
- Remote Patient Monitoring (RCM) and Chronic Care Management (CCM) if needed.
- Evaluation by a pharmacist to review medications and provide education.
- Social work support
- Medication assistance
- Dietician support
- Nurse Educator
- Access to Home Care and Palliative Care services.
Population Management
Executing on risk-based population management by identifying and managing high-risk and rising risk populations early to prevent hospitalization, readmissions and complications.
Conditions treated
Patients with uncontrolled chronic conditions including:
- heart failure
- diabetes
- kidney failure
- COPD
- respiratory illnesses
- advanced malignancy
Patients with Complex Medical Needs: Those with complex medical needs, including multiple medications, treatments, and follow-up appointments who would benefit from coordinated care.
Testimonials
“These folks are GREAT!!! Very knowledgeable pharmacist, Dr was VERY thorough! Very good idea to have this group pull all the disciplines together, question each med, test with full battery of blood tests, etc. Great addition!!!! The nurse was very informative when she called to make my appointment. “
“We have never had such a thorough doctor’s appointment! They were amazing, from the nurse to the pharmacist to the doctor! We could not ask for anything better! Thank you for making this appointment!”
“We live in Elkin but traveled to the TCM clinic after my husband’s stroke. We are so glad we did. Dawn, the TCM nurse’s attention to detail was amazing. She had our therapy set up before we even got home from the TCM appointment. I am so thankful that we got to meet the TCM staff. Elena was wonderful! “
“I truly appreciate the TCM staff. Dawn was there for a very trying time for my mom and myself. She was able to get my mom’s wound taken care of and answered any questions I had. Dr Gopali saw us as a Video visit since mom couldn’t really make it into the office. They were a blessing!”
Advanced Primary Care Team
FAQs
Will my primary care physician be involved in my care?
Yes. The program supports your primary care physician. Your care will be coordinated with your PCP and care will be transferred back to your primary care physician once the acute condition has resolved.
How are these appointments different from following up with my PCP?
These are prolonged appointments of up to an hour with evaluation by a provider, pharmacist, RN nurse educator and access to social work, medication assistance and mental health services.
Will my insurance pay for these visits?
Yes. Most insurance plans, including Medicare, pay for these visits.
Can I utilize these resources if I don’t have insurance?
Yes, the program is available to all patients.
Where are you located?
Our primary clinic is at the One Health Lake Norman clinic at 9611 Sherrill Estates Rd, B, Huntersville, NC 28078. Please call 704-801-1150 to schedule your appointment.
We also see patients at One Health Matthews at 332 North Trade St, 2000 A, Matthews, NC 28105. Please call 704-302-8860 to schedule your appointment.
We offer virtual visits if needed.
Additional Questions
Please call us at 704-801-1150 and we will be happy to answer any additional questions.