Chronic Care Management
Comprehensive care coordination for patients with multiple chronic conditions. Our CCM program provides 24/7 access to a dedicated care team, personalized care plans, and continuous monitoring to improve health outcomes and reduce hospitalizations.
Multidisciplinary Team
CCM Workflow
A streamlined 6-step process to implement and manage chronic care services
Identify Eligible Chronic Patients
Screen your patient population to identify those with two or more chronic conditions who qualify for CCM services. Our team helps you identify eligible patients through EMR data analysis and clinical criteria.
Enroll the Patient
Obtain patient consent and enroll them in the CCM program. We provide all necessary documentation, consent forms, and patient education materials to ensure smooth enrollment and compliance.
Define Care Plan
Create a comprehensive, personalized care plan addressing all chronic conditions, medications, goals, and interventions. Our care coordinators work with your team to develop evidence-based care plans.
Monthly CCM Services
Provide at least 20 minutes of non-face-to-face care coordination per month including medication management, care coordination, health monitoring, and patient education through our dedicated care team.
Track Time
Accurately document all CCM activities and time spent on patient care. Our platform automatically tracks and logs all care coordination activities to ensure proper documentation and billing compliance.
Timely Reimbursement
Submit claims and receive reimbursement for CCM services. We handle all billing and coding to maximize your revenue while ensuring compliance with CMS guidelines and payer requirements.
Ready to Start Your CCM Program?
Our team will guide you through every step of the implementation process
Schedule Your DemoBenefits of CCM
Transform your practice while delivering exceptional care to your patients
Improved Patient Outcomes
Better management of chronic conditions leads to improved health outcomes, reduced complications, and enhanced quality of life for your patients.
Additional Revenue
$40+ per patient per month in additional revenue while providing better care and improving patient satisfaction scores.
Reduced Hospitalizations
35% reduction in hospital readmissions and 24% fewer ER visits through proactive care management and early intervention.
Dedicated Care Team
Access to internal medicine expertise, pharmacy doctors, nurses, and care coordinators working together for your patients.
Zero Practice Burden
Our team handles all care coordination, documentation, and billing - no additional burden on your practice staff.
Full Compliance
Complete compliance with CMS guidelines and payer requirements, with comprehensive documentation and reporting.