Managing diabetes can be challenging, but with the right care management programs, patients can take control of their health and achieve better outcomes! In this video, we’ll dive into how Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and Behavioral Health Integration (BHI) can work together to support diabetes patients on their journey to a healthier life.

The Centers for Medicare & Medicaid Services (CMS) launched Z codes in 2015. They are a set of ICD-10-CM codes that identify non-medical factors that may affect a patient's health status or ability to fully benefit from treatment. They were released for billing and research purposes, yet no reimbursement is associated with their use.

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.