Most CCM vendors demo well. The differences that decide whether your program is profitable show up in enrollment rates, time documentation, and contract terms. This is the evaluation framework we use with clinics — and our selection and negotiation work is free to clinics.
Medicare's Chronic Care Management benefit pays for non-face-to-face care coordination for patients with two or more chronic conditions. Delivering it requires patient consent, a documented care plan, tracked clinical time each month, and clean claims. Chronic care management companies exist because most clinics cannot staff that reliably on top of in-office volume.
Where vendors differ is not the codes — those are fixed by CMS. They differ in how many of your eligible patients they enroll, how defensible the documentation is, how much work lands back on your staff, and what the contract lets you do if it is not working. Program details and code definitions are published by CMS in its Chronic Care Management Services guide.
Ask who actually makes the calls: dedicated care coordinators assigned to your panel, or a shared pool. Confirm licensure, coverage hours, caseload per coordinator, English/Spanish capability, and how escalations reach your providers.
CCM revenue lives or dies on documented time. Review how the vendor tracks minutes against CPT 99490, 99439, 99487 and complex codes, how consent is captured, how they handle overlapping RPM/BHI/TCM, and what their audit documentation looks like.
Bidirectional write-back beats a PDF dropped in a folder. Verify integration depth with your specific EHR version, who builds it, how long it takes, and what your staff must do manually after go-live.
Enrollment rate is the single biggest driver of program economics — but it can't be a one-time push. Enrollment has to be on-going and supported by sustainable, repeatable workflows; with an elderly population you will otherwise only see attrition as patients move, decline, pass away, or disengage. Ask for enrollment percentage on comparable panels, who runs outreach month after month, average time to first billable month, and monthly attrition and re-enrollment rates.
PMPM, revenue share, and per-billable-patient models each shift risk differently. Scrutinize minimums, term length, auto-renewal, termination rights, data ownership and exit assistance before economics.
Request the BAA, security posture, breach history, and two references at clinics of your size and specialty — then actually call them and ask what surprised them in month three.
The right model depends on your panel size, staffing capacity, and how much of the patient relationship you want to keep in-house.
The vendor supplies staff, software, outreach, and billing support. Fastest to launch and lightest on clinic labor; highest per-patient cost and least direct control over patient experience.
Your staff delivers the care using the vendor's time-tracking, documentation, and billing tooling. Lowest cost per patient, but only works when you have staff capacity and a real enrollment plan.
The vendor handles enrollment and after-hours coverage while your team owns clinical touches. A common middle path for clinics that want brand control without hiring a full care team.
We are not a CCM vendor and we do not resell one. We evaluate the market against your panel, run the comparison, and negotiate pricing and terms directly with vendors on your behalf.
Pick a time that works for you — it takes about 15 minutes.
Schedule a callNo cost. No obligation. Prefer email? Reach Stuart directly at Stuart@connectedcareadvisorygroup.com.