Introduction: Chronic Care Management Takes Center Stage

Did you know that more than 60% of Americans suffer from at least one chronic disease, with 40% of those battling two or more chronic diseases? For patients like these, chronic care management (CCM) can dramatically help them sustain better health for a longer period of time. Receiving coordinated chronic care services outside of a physician's office allows patients to engage and access the valuable, multi-disciplinary medical support and services that can positively impact their health while reducing the expenses and lag time associated with visiting multiple clinicians across multiple specialties more readily. Clinician and organization efficiency can also improve as this approach allows practitioners and their teams to provide excellent care while better ensuring they have time available for other care demands and needs.

CCM delivers even more benefits. Medicare and other large payers have embraced chronic care management. Such growing support has resulted in this emerging service delivery to quickly become an established healthcare model. With more than 67 million Americans enrolled in Medicare or Medicare Advantage plans, CCM is a viable new revenue stream for participating organizations. In fact, for organizations with a CCM program, their revenue streams received a sizable boost in the 2022 Physician Fee Schedule final rule. It's evident that the Centers for Medicare & Medicaid Services (CMS) views CCM as a service that provides significant value to patients and one that it has and will continue to support going forward.

If you are considering launching a CCM program or expanding an existing one, it's critical to understand some key principles. Be sure to consider the evolution of the care model, CMS guidelines for coding and billing, and best practices for getting started. We'll walk you through these points — and more — in this comprehensive guide.