This series shares ThoroughCare’s Growth Model. It breaks down each stage to provide a pathway and focus for key strategies and action. These can help optimize performance, outcomes, and revenue at each stage of care management program growth.
The following provides links to each article as they are published for quick reference.
Stage 3: Scalable
Stage 4: Advanced
Medicare care management programs offer a unique opportunity. For primary and specialty care practices, Accountable Care Organizations (ACOs), and integrated health systems, they can help improve outcomes for high-need patients and generate new revenues.
Yet, while these programs' potential is significant, adding new services, workflows, and complexity often deters providers from pursuing them at scale.
We developed the ThoroughCare Care Management Growth Model (Figure 1) to enable clients to assess their current status and establish iterative growth goals on their path toward sustainable, scalable care management.
In this article, we’ll examine the necessary steps to establish more structured program consistency, streamline patient engagement and workflow, and create scale readiness.
Figure 1: ThoroughCare’s Care Management Growth Model
Before a program can scale, it must demonstrate that it consistently delivers quality care, meets compliance requirements, and runs efficiently with its current caseload.
This foundation includes having a:
Stage three, as we call it, Scalable, focuses on creating the standards and structures, as well as having the right digital tools, tracking, and data to support a streamlined care management program.
Growth adds volume and complexity. Without standardized processes, things can quickly fall apart.
For most care management programs, such as Chronic Care Management (CCM), the following five processes are essential:
Entails creating a comprehensive, patient-centered care plan that typically includes the following areas:
It’s key that any clinicians or care managers delivering program services are aware of policies and standards that outline how care plans should be created, reviewed, and updated.
Any workflows or tools should ensure repeatable and consistent execution across all enrolled patients.
For many care management programs, such as CCM or Remote Patient Monitoring (RPM), CMS requires documentation of time spent on non-face-to-face care activities each month.
Time tracking may seem straightforward, but teams that use manual time logs or spreadsheets tend to struggle to provide sufficient evidence if audited. Manual tools are often inefficient and prone to error at scale.
Again, consistent and standardized methods for capturing accurate time and activities are crucial. For example, CCM requires tracking time and meeting time minimums, such as 20 minutes per patient per month for non-complex care or 60 minutes for complex CCM.
Automated timers, real-time documentation, and role-based activity tracking enable care managers and clinicians to focus on patients and interactions rather than capturing elusive data.
One of the most impactful components of programs, such as CCM and Transitional Care Management (TCM), is helping patients achieve continuity of care across various delivery channels, external providers, and services, or after a hospitalization or ED visit.
Successful programs can consistently follow patients through timely transitions as their health status changes or additional support is needed, in an effort to maintain or recover their previous health and functional baseline.
As care management programs mature, they begin to utilize data and communication proactively to enhance transitions and avoid exacerbations or deterioration. Many utilize resources, such as:
Failing to manage transitions not only impacts outcomes but also raises costs and patient dissatisfaction, which in turn affects long-term care management enrollment and revenue.
Not all care management issues can be handled by care managers alone. As a program becomes established and finds its rhythm and workflow, it’s critical to ensure that the care manager and the clinical team have clearly defined protocols for when a patient requires escalation, as well as roles for who should intervene and how.
In stage three, care teams should know when and how to:
This structure supports a growing team while maintaining clinical integrity.
By now, the care manager or care team has established their standard approach to regular patient touchpoints, particularly for ongoing care management programs, such as CCM, PCM, RPM, and Behavioral Health Integration (BHI).
Consistent monthly workflows may follow a schedule as shown in the table below, or they could be established at the beginning of each month based on the risks and triage process used to prioritize patients for engagement.
With any approach, however, a tracking system to ensure accurate time capture and meet minimums is crucial for compliant and reimbursable billing. Additionally, having automated systems that identify high-risk or high-priority patients is vital.
Once monthly time, service targets and patient engagement goals are met, the team must rely on standardized workflows and processes to obtain all necessary supervision sign-offs, confirm that billing requirements are met, and create and submit billing documentation.
Automation and AI technologies aren’t just helpful—they’re essential for scaling an effective care management program.
Artificial intelligence encompasses a range of technologies designed to enhance the efficiency of care management.
ThoroughCare’s generative AI and process automation capabilities are the foundation of how the platform streamlines tasks and allows care managers to oversee more patients with better results.
The following seven software capabilities, coupled with targeted training, can transform a manual and inconsistent service into one that is efficient, data-driven, and delivers improved healthcare and value-based performance outcomes.
ThoroughCare tracks care manager activities, including calls, chart reviews, and assessments in the background or through time-triggered workflows.
The platform automatically logs time spent during patient interactions and documentation, reducing the need for manual entries while ensuring compliance with CMS billing requirements.
The platform utilizes templated care management pathways for various programs, including CCM, BHI, and Annual Wellness Visits (AWVs).
Step-by-step guidance is dynamically tailored to the patient’s data and program eligibility, automatically surfacing next steps, reminders, and required documentation based on rules or patient-specific triggers.
ThoroughCare incorporates validated tools, such as PHQ-9, GAD-7, activities of daily living, and health-related social needs (HRSN) assessments, among others.
The technology ensures that assessments are tailored to the patient's history at each stage of their care plan. Scoring and risk stratification are calculated automatically, and outcomes are tied directly to care plans.
The platform displays patient worklists that can be filtered by due dates, risk scores, program eligibility, or care manager assignments, making it easy to prioritize patient outreach and manage more patients efficiently.
ThoroughCare utilizes algorithms to identify patients who require urgent attention, such as high-risk individuals who are overdue for contact. The system identifies patterns to highlight where intervention is most critical, thereby reducing the likelihood of missing patients.
ThoroughCare’s advanced care coordination tools, integrated with CareCo AI technology, enable users to automate many patient engagement processes, including:
ThoroughCare simplifies compliance and documentation by enabling automated chart updates, providing prepopulated forms, dropdowns, and narrative auto-generation. Integration with partner tools facilitates accurate medication management, enhanced patient engagement, and effective education.
ThoroughCare drives scale by making real-time analytics accessible and easy to interpret through filterable dashboards, data visualizations, and reports for tracking KPIs, such as enrollment, time spent, revenue, missed reimbursement, and patient outcomes.
Predictive analytics and anomaly detection highlight trends in utilization, performance, and compliance. Dashboards are tailored to user roles and update automatically with current metrics.
Tracking indicators of scale-readiness alert healthcare leaders when their care management program is ready to take on a new patient cohort or when a second or third program can be launched.
Look for the following metrics that may indicate a program is scale-ready, including:
ThoroughCare helps new or existing care management programs launch and onboard quickly, avoid and mitigate challenges, and build efficiency to reach growth goals.
Through comprehensive onboarding, tailored expert training, clinical and operations best practices, and customizations and integrations of technology, we partner with providers who want to launch, build, and grow a patient-centered, team-based, high-quality service.