HealthCheck+ at MFM Health
Ongoing Support for Managing Chronic Conditions
Your health matters between visits, too. HealthCheck+ is MFM Health’s coordinated care program designed to support patients managing chronic conditions such as diabetes, hypertension, heart disease, and COPD.
The program may include one or more of the following services, depending on individual care needs:
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Advanced Primary Care Management (APCM)
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Chronic Care Management (CCM)
These services are designed to enhance communication, help monitor ongoing health concerns, and promote consistency in care between visits.
Program Overview
HealthCheck+ provides regular outreach and care coordination outside of standard office visits. Our team connects with patients through scheduled phone calls, virtual check-ins, and, when appropriate, at-home monitoring devices (Remote Patient Monitoring/RPM). These services are designed to help track progress and maintain communication with your care team between appointments.
What is Advanced Primary Care Management (APCM)?
APCM supports patients living with two or more chronic conditions through enhanced coordination and regular follow-up between visits.
This program may include:
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A structured care plan tailored to ongoing health needs
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Communication between healthcare settings and specialists
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Education and monitoring related to chronic conditions and medication use
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The goal of APCM is to promote consistency in care, encourage proactive engagement, and support long-term health management.
What is Chronic Care Management (CCM)?
CCM provides ongoing coordination and follow-up for patients managing chronic health conditions between office visits.
Services may include:
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A structured care plan developed in collaboration with your provider
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Flexible scheduling options, including telehealth appointments and extended office hours
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Outreach from the care management team for routine check-ins and monitoring
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Coordination across healthcare settings, including transitions from hospital to outpatient care
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Education and resources to support medication use, healthy habits, and self-care strategies
What is Remote Patient Monitoring (RPM)?
RPM uses connected health devices to securely share key health data with your care team between visits. Devices may include:
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Blood pressure monitors
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Glucose monitors
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Weight scales
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Pulse oximeters
Data from these devices is reviewed by our pharmacy partners at V-Care Pharmacy and shared with your provider when follow-up may be needed.
RPM supports ongoing communication and helps track trends in your health over time, allowing your care team to stay informed between appointments.
Note: RPM may be recommended based on your health needs. Coverage and costs vary by insurance; our team can provide additional information before enrollment.
Continuous Support
A dedicated care coordinator maintains regular communication with you between visits to review updates, monitor ongoing needs, and help coordinate next steps in your care plan.
Coordinated Care
Your care team works collaboratively with your primary care provider and specialists to support communication, continuity, and alignment across all aspects of your health.
Ongoing Monitoring
Regular communication and data review help your care team stay informed about changes in your health between visits, allowing for timely follow-up when needed.
Convenience
Receive care coordination and support between visits through scheduled phone or virtual check-ins, reducing the need for additional office appointments.
Benefits of HealthCheck+ at MFM Health
How do I know if I’m eligible?
Patients who have two or more chronic health conditions expected to last 12 months or longer may qualify for HealthCheck+. These conditions can include diabetes, high blood pressure, heart disease, asthma, depression, or other ongoing health concerns.
You may be contacted by MFM Health with information about enrollment, or your provider may review the program with you during an appointment. If you’re unsure about eligibility, your care team can assess your medical history and determine whether participation in HealthCheck+ is appropriate for your ongoing care.