What Is Chronic Care Management?
Chronic Care Management (CCM) is a Medicare program designed to provide comprehensive, coordinated care for patients who are living with multiple chronic conditions. Launched by the Centers for Medicare and Medicaid Services (CMS), the CCM program recognizes that managing two or more chronic diseases is complex and requires more than occasional doctor visits.
Through CCM, patients receive dedicated support from a care team that helps coordinate their healthcare, manage medications, monitor symptoms between office visits, and ensure that all providers involved in their care are communicating effectively. The goal is to improve health outcomes, prevent complications, and reduce hospitalizations — all while empowering patients to take an active role in managing their health.
At Sterling Health Solutions, we provide CCM services to patients throughout the Dallas-Fort Worth metroplex. If you or a loved one are managing multiple chronic conditions, this guide will help you understand whether you qualify and how to get started.
Medicare CCM Eligibility Requirements
To qualify for Medicare-covered Chronic Care Management services, patients must meet the following criteria:
- Two or more chronic conditions — You must be diagnosed with at least two chronic health conditions that are expected to last 12 months or longer.
- Conditions place health at significant risk — The chronic conditions must place your health at significant risk of decline, complications, or death without ongoing management.
- Medicare Part B coverage — You must be enrolled in Medicare Part B. Many Medicare Advantage plans also cover CCM services.
- Patient consent — You must provide verbal or written consent to participate in the CCM program. Enrollment is always voluntary.
Qualifying Chronic Conditions
A wide range of chronic conditions may qualify you for CCM services. The following are among the most common qualifying conditions:
This is not an exhaustive list. Many other chronic conditions may also qualify. If you have two or more ongoing health conditions that require regular medical attention, we encourage you to contact us to discuss your eligibility.
What CCM Services Include
When you enroll in Chronic Care Management with Sterling Health Solutions, you gain access to a comprehensive suite of care coordination services designed to help you manage your health more effectively. CCM services include:
- Development and regular updates to a comprehensive care plan
- Medication review and management
- Coordination between all your healthcare providers and specialists
- 24/7 access to your care team for urgent health concerns
- Assistance with scheduling appointments and follow-ups
- Ongoing health education and self-management support
- Regular check-in calls to monitor your symptoms and progress
- Transition support after hospital stays or ER visits
These services are provided by our dedicated care coordination team, which includes registered nurses and clinical support staff who specialize in chronic disease management.
How to Enroll in CCM
Getting started with Chronic Care Management at Sterling Health Solutions is straightforward. Here is the enrollment process:
- 1
Contact Us
Reach out to our team by phone or through our website. We will ask a few questions about your health conditions and insurance coverage.
- 2
Eligibility Verification
We verify your Medicare eligibility and confirm that your chronic conditions meet the program requirements. We handle all the paperwork and coordination with your physician.
- 3
Physician Authorization
Your primary care physician must order CCM services. If your physician is not yet familiar with the program, our team will provide them with all the information they need.
- 4
Care Plan Development
Once enrolled, we develop a personalized care plan that addresses all of your chronic conditions, medications, healthcare goals, and preferences.
- 5
Ongoing Support
You begin receiving regular check-in calls, medication reviews, care coordination, and 24/7 access to your care team. Your care plan is updated regularly as your needs evolve.
Cost: Typically Covered by Medicare Part B
One of the best aspects of the CCM program is its affordability. Because CCM is a Medicare Part B benefit, most of the cost is covered by Medicare. Patients are typically responsible only for the standard Medicare Part B copayment, which is generally 20 percent of the Medicare-approved amount. However, if you have a Medigap supplemental policy or Medicaid as a secondary insurance, your copayment may be reduced to zero.
At Sterling Health Solutions, we believe that financial concerns should never be a barrier to receiving the care you need. Our team will review your coverage in detail before you enroll and ensure that you understand any potential costs.
Frequently Asked Questions About CCM
How many chronic conditions do I need to qualify for CCM?
You must have at least two chronic conditions that are expected to last 12 months or longer and place your health at significant risk. These conditions must require ongoing management and coordination of care.
Will I have to pay anything out of pocket for CCM?
CCM is covered by Medicare Part B. Most patients have little to no out-of-pocket cost. If you have a Medigap or supplemental insurance plan, your copayment may be fully covered. Our team will review your specific coverage during enrollment.
Can I still see my regular doctor if I enroll in CCM?
Absolutely. CCM is designed to work alongside your existing healthcare providers, not replace them. Our care team coordinates with your primary care physician and specialists to ensure everyone is aligned on your care plan.
What happens during a CCM check-in call?
During a check-in call, a member of your care team will review your current symptoms, discuss any changes in your health, review your medications, answer questions, and update your care plan as needed. These calls typically last 15 to 30 minutes.
Can I unenroll from CCM if I change my mind?
Yes. Participation in CCM is completely voluntary. You can unenroll at any time by notifying your care team. There are no penalties or fees for discontinuing the program.
Do I need to have Medicare to qualify?
Medicare Part B coverage is required for CCM services to be covered. If you have Medicare Advantage, CCM may also be available depending on your plan. Contact us to verify your eligibility.