Services / Chronic Care Management

Chronic Care Management

Monthly care coordination for patients managing two or more chronic conditions — the ongoing work that keeps care plans current.

What It Is

The monthly coordination chronic conditions require

Chronic Care Management (CCM) is at least 20 minutes each month of non-face-to-face care coordination for patients with two or more chronic conditions — medication reconciliation, care plan updates, and consistent communication that keeps small issues from becoming missed diagnoses. CHMS runs this end-to-end on your behalf.

What's Included
  • Medication reconciliation & care plan updates
  • Monthly patient & caregiver communication
  • Coordination with community & support services
  • Monthly provider updates
How It Works

Identify

Patients with 2+ chronic conditions.

Build the Plan

Individualized & kept current.

Monthly Outreach

20+ minutes of coordination.

Close the Loop

Provider stays informed.

Benefits
  • Fewer avoidable ER visits and readmissions
  • Higher patient compliance and satisfaction
  • Added, CMS-supported revenue
Related Programs

Often paired with CCM

Remote Patient Monitoring

Adds daily vitals to the monthly coordination CCM provides.

Learn more

Remote Therapeutic Monitoring

Tracks therapy and medication adherence alongside CCM.

Learn more

Ready to coordinate care more proactively?

Let's talk about which patients are eligible for CCM.