Chronic diseases have become a central workload for internal medicine services in Saudi Arabia, where diabetes, hypertension, cardiovascular disease, chronic kidney disease, obesity, chronic respiratory disease and fatty liver disease frequently coexist in the same patient. Conventional clinic structures still tend to manage each diagnosis through separate appointments, separate targets and delayed specialist referral, which increases therapeutic inertia, patient burden and avoidable admissions. This review proposes a Saudi Vision 2030-aligned internal medicine care pathway for chronic disease management that integrates early risk detection, multimorbidity assessment, shared care planning, protocolized escalation, patient education, digital follow-up and outcomes governance. A narrative review method was applied to evidence published from 2020 to 2025, including Saudi health transformation literature, international clinical guidelines, chronic disease implementation frameworks and recent Saudi studies on noncommunicable disease burden. The proposed pathway places internal medicine as a coordination hub between primary care and organ-based specialties. It recommends risk-based screening, medication optimization, multidisciplinary review, digital monitoring, patient-reported outcomes and value-based key performance indicators. The review concludes that pathway redesign can support the Health Sector Transformation Program by improving continuity, standardizing chronic disease care, reducing duplication and strengthening prevention before complications occur.