Chronic Care Management (CCM)

Educational information for Medicare beneficiaries and families seeking to understand Chronic Care Management (CCM) and how ongoing care coordination may support individuals living with multiple chronic conditions.

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Care coordination is designed to help ease this burden by supporting organization, communication, and continuity of care in collaboration with a patient’s physician.​

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Chronic Care Management is generally intended for Medicare beneficiaries living with two or more chronic conditions, such as diabetes, hypertension, heart disease, COPD, arthritis, or similar long-term conditions.

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Examples of CCM-related support activities discussed in educational materials may include:

• Coordinate medical appointments, lab work, and specialist visits

• Review medications and help update care plans

• Communicate with healthcare providers to avoid duplication of services

• Offer monthly phone-based check-ins to monitor progress

• Provide education and connect patients to community or social resources

• Support families by offering updates and guidance on the care plan

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These examples are provided for general educational purposes and do not represent services offered or enrollment into a care management program.

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Chronic Care Management is a Medicare-approved care coordination approach that requires patient consent and physician involvement. Coverage rules and cost-sharing obligations are determined by Medicare and may vary based on individual circumstances.

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If you would like general educational resources and information about Chronic Care Management, please click here.

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📧 info@medcareoutreach.org
📞 954-248-0096​