Creative Links to BridgePoint Advocacy

Personal Mission: 20 years of LPN experience in the healthcare industry offering chronic care coordination and patient care advocacy for acute/chronic care filling a huge gap in healthcare by offering support between healthcare visits.  Please note, I am not a physician, and I cannot diagnose, but with consent, I will offer support being a patients liaison providing ongoing personalized support for acute/chronic conditions. 

My goal: To empower individuals living with chronic conditions by providing personalized, in-between-visit care coordination, education, and advocacy—reducing hospitalizations, improving health outcomes, and supporting caregivers in navigating the healthcare system.

Education:

  • LPN Compact License - LA, since 2005
  • Bachelors General Sciences with concentration Applied Sciences, anticipated graduation 2026
  • Bachelors in Health Information Management, anticipated graduation 2026

Who could benefit from CCM:

  • Need education regarding commobidities
  • Need  education regarding medications
  • Needs motivational interviewing to help them make better lifestyle choices
  • Patient is having issues with uncontrolled symptoms realted to chronic conditions
  • Patient frequently calls the clinic
  • Patient is frequently in ER or Hospital for chronic illness like: Diabetes, CHF, COPD, and more
  • Recently discharge patients at risk of readmission
  • Family caregivers who need guidance
  • Patients with mobility or transportation challenges
  • Low-income or underserved populations

Medicare

CCM / Education

  • Medicare offers a program a called Chronic Care Management(CCM) with only one provider offering services
  • Patients are encouraged to sign up to help with multiple conditions by monitoring the condition to ensure the treatment by your physician is working; reducing going to ER/Hospital 
  • Provide patient advocacy and support by reminding patients of physician appointments, appointment of labs / test due, and to provide education
  • Advocate will contact patient Weekly or Monthly to help you achieve your goals
  • Post-discharge / transition recovery
  • Diabetes 
  • Depression
  • COPD
  • Heart failure
  • CKD / ESRD
  • A-fib
  • Alzheimer's disease
  • Anemia
  • Cancer 
  • Ischemic heart disease
  • Parkinson's disease
  • Stroke / TIA
  • Osteoporosis 
  • Hyperthyroidism
  • Hypertension*
  • Asthma
  • Pneumonia
  • Hyperlipidemia*
  • AMI
  • Rheumatoid / Osteoarthritis*

*Chronic Conditions Warehouse (CCW), Medicare Chronic Condition Charts 2025

Chronic Conditions Warehouse (CCW)

Chronic Care Coordination and Patient Advocacy Services

Let's talk about your current diagnosis, medications, along with your healthcare goals!

  • Chronic Care Check-ins (phone, virtual, or text)
  • Medication and Care Plan Follow-up
  • Patient Advocacy & Physician Communication Support
  • Hospital Discharge Follow-up & Recovery Support
  • Education on Chronic Condition Management
  • Referrals to Community and Health Resources
  • Caregiver Coaching and Navigation Help

Payment

  • Direct Pay Services: Monthly subscriptions
  • Healthcare Partnerships: Contracted support for primary care clinics, specialists, or home health agencies
  • Long-Term Goal: Qualify for Chronic Care Management (CCM) reimbursement through Medicare with provider partnership

Future Growth

  • Offer group classes or virtual health workshops (on Zoom)
  • Partner with home health or assisted living facilities
  • Education content: YouTube, podcasts
  • Offer caregiver support sessions
  • Partner wih local physicians, hospitals, and clinics
  • Utilize AHIMA, HIMSS, and communtiy health directories