(May 2026) – Medicare care management programs, such as Chronic Care Management and Advanced Primary Care Management, have repeatedly demonstrated their ability to improve patient outcomes and reduce health care costs while ensuring providers are fairly reimbursed for the additional care they deliver.
As a result, many practices and health systems without care management programs are considering whether to launch one internally or partner with a vendor. But how do you decide?
Chronic Care Management, introduced by the Centers for Medicare & Medicaid Services in 2015, has reduced costs and improved patient care for more than a decade. A national report based on CMS claims data found that CCM reduced hospitalization claims by 4.7 percent and costs by $888 per beneficiary per year.
But this program has strict compliance requirements and demands dedicated staff, technology and processes. If you launch an internal CCM program without a comprehensive plan, it will likely flounder, with low enrollment, costs that exceed revenue and limited impact on your patients.
A clear plan and, potentially, the right vendor can ensure your program reaches all patients who need it, improving their care and justifying the cost of the program infrastructure.
What Is Chronic Care Management?
CCM may be offered under general supervision, meaning the billing practitioner need not personally perform the services, but the services must be provided under the billing practitioner's overall direction.
The CCM program must include critical elements, such as:
- An initiating visit (for patients who have seen their provider within the past year)
- Patient consent
- An electronic, comprehensive care plan
- Twenty-four hours/seven days a week access to care
- Comprehensive care management
- Support during care transitions (coordinate care among providers, update care plan after hospital or ER visits)
To bill for Chronic Care Management in compliance, you must determine which patients are eligible and obtain their consent before enrolling them. You must also have enough staff to:
- Build care plans for each patient
- Operate a 24/7 care line
- Offer 20 minutes of personalized care per patient, per month
Performing all of these functions requires extensive infrastructure, staffing, and technology. To learn more about successfully launching a program, read ChartSpan's full guide.
To learn more about ChartSpan, reach out to Jason Meadows at (334) 799-6730 or jason.meadows@chartspan.com.