Did You Know? More Than 250 Local Residents Have Received Extra Support Through CCMH Community Health Programs

September 25, 2026

CARROLLTON, Mo. – Managing a chronic condition, recovering after a hospital stay, or navigating healthcare services can be overwhelming. That’s why Carroll County Memorial Hospital (CCMH) offers community health programs designed to help patients stay healthier, access needed resources and receive personalized support close to home.

Through programs such as Chronic Care Management (CCM), Transitional Care Management (TCM), and the Medicaid Primary Care Health Home (PCHH) program, CCMH’s Population Health team is helping local residents take a proactive approach to their health.

To date, CCMH nurse care managers have assisted more than 250 patients living with chronic health conditions such as diabetes, chronic obstructive pulmonary disease (COPD), heart disease, kidney disease, and other long-term illnesses.

“Many chronic conditions require ongoing attention and coordination,” said Shelbie Alexander, CCMH Director of Community Health. “Our nurse care managers serve as partners in a patient’s healthcare journey. They help coordinate appointments, ensure follow-up care is completed, answer questions, and help patients stay on track with medications and treatment plans. The goal is to help people live healthier lives while avoiding unnecessary hospital visits.”

The CCM program is available to qualifying Medicare and Medicaid patients with certain chronic health conditions, while the TCM program provides additional support to patients following an inpatient hospital stay at CCMH. TCM does apply to any patient who has a primary care provider at CCMH, regardless of where they have been an inpatient in a hospital.

According to Alexander, one of the greatest advantages of receiving care in a rural community is the ability to build meaningful relationships with patients.

“The care is truly personal at CCMH,” Alexander said. “Our care managers know the people they serve. Because we’re part of the same community, we’re able to spend more time listening, understanding individual needs, and helping connect patients with the services that will make the biggest difference in their lives.”

In addition to care management services, CCMH is committed to helping patients access healthcare coverage and financial assistance programs. Community Health Worker Shandi Duff assists individuals who may qualify for Medicaid but are not currently enrolled and can guide them through the application process.

Duff also conducts care-gap outreach, helping patients stay current on preventive screenings and routine healthcare services. Whether a patient is due for a mammogram, colonoscopy, annual wellness visit, or another preventive screening, the outreach efforts help ensure important care isn’t overlooked.

Behavioral health is another critical component of CCMH’s community health services. Cindy Cauble, Licensed Clinical Social Worker (LCSW) and Behavioral Health Consultant, works closely with Medicaid Primary Care Health Home patients to address behavioral health needs and provide support for overall well-being.

“As healthcare continues to evolve, we’re seeing a greater need for integrated behavioral health services, especially in rural communities,” Alexander said. “Having those resources available at CCMH helps ensure patients can receive more comprehensive care close to home.”

A major focus of CCMH’s Population Health team is preventive care. Rather than waiting until a condition worsens, the team works to identify health concerns early and help patients manage them before they lead to hospitalization.

“Healthcare is increasingly focused on prevention and long-term wellness,” Alexander said. “Being proactive rather than reactive benefits everyone. The earlier we can help patients manage chronic conditions, the better their quality of life can be and the less likely they are to experience serious complications down the road.”

CCMH is also helping remove transportation barriers that can prevent patients from receiving the care they need. Through a new Mobile Integrated Health Program, CCMH’s Population Health team has partnered with Jefferson Medical Group (JMG) and the local ambulance district to provide additional support for patients who frequently need assistance.

Under the program, ambulance personnel receive training similar to community health workers and can make home visits to check on patients, assess their needs, and help connect them with healthcare services and resources when transportation or other challenges arise.

Through these innovative programs and partnerships, CCMH continues to strengthen its commitment to providing personalized, accessible, and community-focused healthcare.

Residents interested in learning more about CCMH’s community health programs, Medicaid assistance, or care management services are encouraged to contact Carroll County Memorial Hospital for additional information.

CCMH is dedicated to improving the health and well-being of the communities it serves through compassionate care, innovative programs, and a patient-centered approach to healthcare. By combining clinical excellence with strong community partnerships, CCMH continues to meet the evolving healthcare needs of Carroll County and surrounding areas.

For more information about the services at Carroll County Memorial Hospital, visit our website http://www.carrollcountyhospital.org or call 660-542-1695.

Carroll County Memorial Hospital (CCMH), the area’s premier healthcare resource, is a 25-bed Critical Access facility serving Carrollton and the surrounding communities. It offers 24-hour emergency care, specialized services such as advanced diagnostics, post-acute skilled care (swing bed) and comprehensive family care. CCMH is dedicated to the Health and Well Being of All We Serve. For more information, visit carrollcountyhospital.org.

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