When deciding to start a new care management program or scale an existing one, there are many questions to answer, including:

Care management program success depends on keeping patients actively enrolled in the program until they achieve their health and wellness goals, their health risk decreases, and they can confidently self-manage their chronic conditions. When this happens, they can graduate from the program and return to traditional disease management.

Health systems are looking for ways to improve care outcomes and patient experiences while building cash flow and enhancing pay-for-performance.

The Centers for Medicare & Medicaid Services (CMS) has released the proposed rule for its 2025 Medicare Physician Fee Schedule.

Approximately 93% of primary care physicians wish they had support to better engage patients with multiple chronic conditions, according to a Quest survey.

An opinion piece in the American Academy of Family Physicians’ (AAFP) FPM journal identified care management as an “essential strategy” for success in primary care practices. Despite growing evidence demonstrating its potential to improve the health of the most at-risk patients, Chronic Care Management (CCM) adoption by rural providers has been slower than their urban counterparts.

Data integration and interoperability enable greater capabilities to capture and share patient information, supporting new models like value-based care management.

Primary care is the foundation of US healthcare. It’s reported that primary care is the “only” area in which providing more services—such as childhood vaccines and regular blood pressure screenings—is linked to better population health and more equitable outcomes.

Physicians and other qualified providers working within nursing and assisted living facilities can deliver covered care management services, according to The Centers for Medicare & Medicaid Services (CMS). So long as they meet all billing requirements, and the claim is submitted using a specific NPI number. These services include:

Combining Chronic Care Management with Remote Patient Monitoring can improve clinical outcomes, lower total cost of care, and enhance patient satisfaction.