This is where you get straightforward answers to the everyday challenges of running a care management program. Got a billing question? A workflow breakdown? A staffing dilemma? Send it in. We answer selected questions in our monthly Q&A column, Dear Care Management Guy. All questions are reviewed by real operators, and many get featured anonymously on the blog to help others facing the same issues or challenges.
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Care management is a proactive, team-based approach that helps practices support patients—especially those with chronic conditions—between visits. It combines clinical coordination, patient engagement, and administrative processes to improve outcomes, reduce costs, and sustain long-term program success.
Care management is for practices that care for patients with chronic conditions and want to deploy a more proactive care strategy for their patients. It’s especially valuable for providers who participate in ACOs and value-based care, but it also works as a natural glidepath for providers who want to evolve into value-based care from fee-for-service models.
Chronic Care Management (CCM): Alerts your staff so they can focus on getting the right care to the right patient at the right time.
Remote Patient Monitoring (RPM): Captures device-based vitals and self-reported subjective data to help slow disease progression.
Principal Care Management (PCM): Get real-time updates on at-risk patients and auto-capture reimbursable activities.
Advanced Primary Care Management Services (APCM): APCM provides a flat fee per primary care patient per month with no need to track time.
Transitional Care Management (TCM): Prevent gaps in care when your team is informed about patients transitioning between care settings.
Behavioral Health / Care Collaboration (BHI): Improve patient outcomes and maximize reimbursement between providers and behavioral health professionals.
Remote Therapeutic Monitoring (RTM): RTM codes include non-physiologic data monitoring for multiple areas.
Not necessarily. You can start with what you have, but using a purpose-built, interoperable platform makes it a lot easier to scale, stay compliant, optimally engage patients, and generate the additional revenue that you need for long-term sustainability.
No. While Medicare was the first large payer to incentivize for chronic care management (CCM), many Medicaid and commercial payers now reimburse for care management, especially when it supports better outcomes, fewer hospitalizations, and fewer avoidable appointments.
You don’t need extra staff to get started—many practices launch using their existing team. That said, as the program grows, it’s often profitable to build a dedicated care management team to improve patient outcomes and maximize practice revenue.
