Chronic care management
by telehealth.
Ongoing support for people living with multiple chronic conditions. We help patients understand their care plan, navigate medications and follow-up, and stay connected to their clinical team.
Support that continues
between appointments.
Life happens between appointments. Chronic care management gives patients and families a connected team they can rely on in the time between visits with their doctors.
Our nurse practitioner-led model brings care management, clinical oversight, medication coordination, and patient education together around the needs of each person. When a primary care relationship exists, we strengthen it. When one is missing, we help establish appropriate access.
“Care does not stop when
the episode ends.”
A plan the patient
understands and can follow.
- Understanding the care plan
- Medication coordinationKeeping medications and changes clear and organized across providers.
- Navigating follow-up appointments and next steps
- Patient education about living with chronic conditions
- Staying connected to the patient's clinical team
People managing more
than one condition.
Chronic care management is designed for people living with multiple chronic conditions who want more support between visits. Programs are tailored to clinical needs, patient goals, eligibility, and the care already in place.
Family members and caregivers can be part of the plan, with the patient's permission. Everything is delivered by telehealth, so there is no need to travel to an office, anywhere in Texas.
Coverage and out-of-pocket costs depend on the program, insurance benefits, and individual eligibility. Our team reviews available benefit information and discusses potential patient costs before enrollment.
From the first conversation
to a coordinated plan.
Connect
A patient, family member, or healthcare partner contacts Trinity to discuss a need.
Understand
We review clinical needs, program fit, coverage, and the patient's existing care relationships.
Plan together
With patient consent, we establish goals and coordinate the next steps with the care team.
Stay connected
Ongoing outreach, education, and communication help keep the plan moving forward.
Does Trinity work with my current doctor?
Yes. Our approach is to support existing provider relationships and coordinate with the patient's clinical team. If primary care access is missing, we help identify an appropriate path to care.
Can family members or caregivers be involved?
With the patient's permission, family members and caregivers can participate in care planning, education, and communication about the patient's needs and goals.
Do I need to travel or come to an office?
No. Trinity's care is delivered entirely by telehealth, so no in-person visit is required.
Better care begins
with a conversation.
Refer a patient, ask about a program, or explore a partnership. Our intake team can help identify the right next step. Telehealth across all of Texas.