Steady follow-up, not once-a-year firefighting
Chronic disease management
Diabetes, high blood pressure, high cholesterol, asthma and COPD, thyroid disease, heart failure and obesity, managed with scheduled follow-up, home readings and a care coordinator who calls between visits.
What this covers
Chronic conditions do not improve because of one good appointment. They improve because somebody checks in often enough to notice a trend. Riverbend runs a chronic care program with scheduled follow-up intervals, home monitoring, medication adjustment between visits and a care coordinator who phones patients whose numbers are drifting.
We manage type 1 and type 2 diabetes, hypertension, hyperlipidemia, asthma, COPD, hypothyroidism, stable heart failure, chronic kidney disease in its earlier stages and weight management. Patients with several conditions are seen more often and get a written plan that fits them rather than one plan per disease.
Riverbend also runs a monthly diabetes education group at the Riverpoint clinic, and a pharmacist reviews the medication list of every patient taking more than eight prescriptions.
What is included
Everything below is part of this service at all Riverbend clinics that offer it.
Scheduled follow-up
Visit intervals set by your condition and control, typically every three to six months.
Home monitoring
Blood pressure cuffs and glucose meters checked against ours, with readings reviewed in the portal.
Medication adjustment
Changes made between visits when readings call for it, rather than waiting for the next appointment.
Care coordinator calls
A coordinator phones patients whose numbers are drifting or who missed a refill.
Diabetes education group
A monthly session at Riverpoint on food, feet, glucose patterns and insulin technique.
Pharmacist review
A full medication review for anyone on more than eight prescriptions.
How a visit runs
Baseline visit
A long appointment to review history, labs, medication and what has and has not worked before.
Set targets together
Numbers you agree with, written down, with the reasoning behind each one.
Monitor at home
You log readings; we watch the trend between visits and adjust when needed.
Review and adjust
Follow-up visits check progress, side effects and anything that has changed in your life.
Why patients choose this here
- Follow-up intervals matched to your control, not a fixed calendar
- Medication changes between visits when readings justify them
- A care coordinator who calls before things go wrong
- On-site A1c and lipid testing with results the same day
- One plan for all your conditions rather than several competing ones
Sample costs
- Chronic care follow-up$130 self-pay (sample)
- Baseline long visit$210 self-pay (sample)
- A1c test$28 self-pay (sample)
- Diabetes education groupNo charge for Riverbend patients
Sample self-pay figures for illustration. Most chronic care visits are billed to insurance, and many plans cover diabetes education and preventive lab work in full.
Providers for this service
Any of these providers can see you for chronic disease management.
Chronic disease management questions
Usually every three to six months, more often just after a diagnosis or a medication change. The interval is set by how stable your readings are, not by a fixed rule.
Often yes. If you are sending in home readings, your provider can adjust a dose through the portal and bring you in only when an exam is needed.
We co-manage type 1 diabetes with an endocrinologist, handling day-to-day care here and referring for pump and continuous monitor management.
Tell us. There is almost always a cheaper option, a patient assistance program or a different dosing strategy, and we would rather find it than have you skip doses.
Book chronic disease management
Request a time online and the front desk confirms by text the same business day, or call and talk it through with a person.
Most major Washington plans accepted. Sample self-pay rates published for every visit type.