Chronic Care Management

The Centers for Medicare and Medicaid Services (CMS) recognizes the critical role of chronic care management (CCM) in primary care programs that contribute to better health and care for individuals. Under the program, designated clinicians who manage Medicare beneficiaries with multiple (two or more), significant chronic conditions can receive a monthly, per beneficiary fee for time spent outside of office visits for tasks such as care coordination, patient communication, medication refills and care provided electronically or by telephone.


Earn
$36 to $50
per 30 day period,
depending on region and
locality


Earn
$432 to $600
per year, per patient


Providing workflow management to support your CCM program

HealthEC provides a scalable technology platform that meets all CMS requirements and unifies communication and care coordination:

  • Identifies qualified patients through advanced healthcare analytics tools
  • Creates a person-centered, electronic care plan based on physical, mental, cognitive, psychosocial, functional, and environmental assessments, and an inventory of resources
  • Helps care managers organize and implement care through work lists and dashboards
    • Preventive care services
    • Medication reconciliation, with review of adherence and potential interactions
    • Care coordination with home and community based clinical service providers
    • Transitional care management between and among health care providers and settings, including referrals to other clinicians, and follow-up after emergency department visits and facility discharges
    • Community and social service resource access
    • Systematic re-assessment of medical, functional and psychosocial needs

Answering your questions

Why have a CCM program?
Who can provide CCM services?
What are the CCM requirements?

For more answers, consult the CMS CCM fact sheet
BECAUSE QUALITY OF LIFE MATTERS
HealthEC supports providers in managing chronic illnesses and teaching patients how to live successfully with them:
  • Coordinating care across multiple specialists
  • Teaching self-management and coping mechanisms
  • Tightly managing medication therapies
  • Facilitating access to community resources
  • Optimizing communication through secure messaging, alerts and health tracking tools
View PHM Webinar Recording
Improving care and quality of life for millions of beneficiaries


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