All You Need to Know About Chronic Disease Management Plans

Key Takeaways

• CDM plans support patients with long-term conditions
• They provide access to Medicare-funded allied health services
• Coordinated care reduces duplication and improves outcomes
• Plans require regular review for continued effectiveness
• Harbour Town Doctors offers tailored CDM plans for eligible patients

What is a Chronic Disease Management Plan?

A Chronic Disease Management plan (CDM), sometimes referred to as a GP management plan, is a structured healthcare plan created for patients with long-term medical conditions. These conditions typically last six months or longer and require ongoing medical attention.

Examples of chronic conditions include:

• Diabetes
• Asthma
• Heart disease
• Arthritis
• Cancer
• Chronic obstructive pulmonary disease (COPD)

According to research  reports almost half of all Australians live with at least one chronic condition, highlighting the importance of structured management.

Why Chronic Disease Management Matters

Chronic conditions affect not only physical health but also emotional well-being, financial stability, and lifestyle. Without a coordinated plan, patients often experience fragmented care, repeated tests, or overlooked treatments.

A CDM Plan ensures:

• Clear communication between healthcare providers.
• Access to allied health services under Medicare.
• Preventive strategies to manage symptoms and reduce complications.
• Long-term monitoring of health progress.

Who is Eligible?

You’re eligible for a CDM plan if you have a chronic medical condition that has been (or is expected to be) present for six months or more. This includes, but isn’t limited to:

• Diabetes
• Heart disease
• Asthma or COPD
• Arthritis
• Osteoporosis
• Cancer
• Chronic pain
• Mental health conditions
• Autoimmune diseases
• Obesity
• Stroke recovery
• Long COVID

You don’t need to be elderly, and you don’t need to have multiple conditions, just one recognised chronic condition is enough to qualify.

How Does It Work?

It all starts with a visit to your GP. During this appointment, your doctor will:

• Assess your current health and medical history
• Identify the chronic condition(s) that require ongoing care
• Work with you to set health goals
• Create a management plan tailored to your needs
• Refer you to appropriate allied health professionals if needed

If you also require care from multiple providers (e.g., your GP, a physio, and a dietitian), your GP might also set up a Team Care Arrangement (TCA). This ensures everyone involved in your care is on the same page and working together.

What Services Can You Access Under a CDM Plan?

A chronic disease management plan gives you access to up to five Medicare-subsidised allied health sessions per calendar year. These could include:

• Physiotherapy – For pain management, rehab, or mobility
• Podiatry – For foot and ankle care, especially for diabetics
• Exercise Physiology – For structured movement and recovery
• Dietitian Services – For managing weight, diabetes, or gut issues
• Occupational Therapy – To support independence at home or work
• Psychology/Counselling – For managing mental health or lifestyle changes
• Speech Pathology – If communication or swallowing is affected

It’s important to note that the five sessions are shared across all referred services, not five per type of provider.

How Much Does It Cost?

Medicare covers a portion of the cost through a rebat. Some providers bulk bill, meaning you won’t pay anything out of pocket. Others may charge a gap fee, depending on their rates.

It’s always a good idea to ask about fees when booking with an allied health provider under a CDM referral.

How Long Does the Plan Last?

CDM plans are valid for 12 months, and you can review and renew them annually with your GP. You may also be eligible for a review sooner if your health changes or new issues come up.

During your review, your GP will check on your progress, adjust goals, and reissue any necessary referrals.

Benefits of a CDM Plan

There’s more to a CDM plan than just saving money, it’s about improving your quality of life. Benefits include:

• Better access to coordinated care
• Clear health goals and accountability
• More control over managing your condition
• Early detection of worsening symptoms
• Improved communication between your healthcare team
• Financial relief through medicare support

Having a CDM plan is the first step towards taking control of their chronic condition, rather than just reacting to flare-ups.

Tips to Get the Most Out of Your CDM Plan

• Be Honest with Your GP – They can only help with what they know
• Follow Through on Referrals – Don’t let sessions go to waste
• Track Your Progress – Use a journal or app to record symptoms, medication, or improvements
• Attend Your Annual Review – Keeping the plan updated ensures your care stays relevant
• Ask About Additional Support – You may be eligible for other services under programs like My Aged Care or the NDIS

Myth-Busting: Common Misunderstandings

• “Only older people qualify” – False! People of all ages can access CDM plans.
• “I need multiple conditions to be eligible” – One chronic condition is enough.
• “I get five sessions per provider” – Not quite. You get five total per calendar year across all services.
• “It’s too hard to set up” – Your GP does most of the work. You just need to book the appointment for chronic disease management service and be open about your health.

Conclusion

Chronic conditions demand more than one-off treatment. A well-structured chronic disease management plan ensures ongoing care, coordinated services, and financial support through medicare. Harbour Town Doctors provides comprehensive CDM plans tailored to each patient’s needs, helping individuals and families manage long-term health with confidence. Ready to take control of your health? Contact us today to book a consultation and create your personalised chronic disease management plan.

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