How to Qualify Your Patients for CCM Part 2

In part 1 of “How To Qualify Your Patients For CCM,” we defined the eligibility of the patient for such a program, and we determined that the highest risk patient would be the one who was recently hospitalized or is regularly in the ER.  With this installment, let’s look at two other subcategories of patients who would benefit from Chronic Care Management.


The second subset of patients that you can start identifying as needing Chronic Care Management would be those who regularly call the clinic.  These patients’ calls are often regarding one of three common subjects: (1) symptom management, (2) medical questions or requests, or (3) prescription refills.

The patients that are constantly calling your office are good patients to be on the program.  Giving them a nurse that is in constant contact with them will cut down on the amount of time your staff spends dealing with those particular patients.  We are not referring to the patients that call in once in a blue moon—that is not whom we are really addressing. We are talking about those patients that are just constantly calling, every week they are calling because they have a question or because they have issues or because they have something going on.  These are the perfect patients for which Chronic Care Management programs were established.  If they have those two or more qualifying conditions, then those are the patients that are not only going to need the program, but they are going to love being a part of the program.  This is because they are proactive in their care and they are very much concerned about their health in general.  

Those patients that are placing regular calls to you are going to be the patients that will be 100% invested in this program.  They are wanting and needing a program like this.  You are going to be able to take care of the prescription refills.  They are going to be able to get answers that they need right away.  They are going to be able to get everything that they are wanting and needing from the Chronic Care Management nurse.


The third set of Chronic Care Management patients can be identified based on the number of specialists involved in their care.  In addition, they have limited social or limited local family.  These points together make for a good identifier.  These patients may be completely on their own in your area.  You need to get them into this program.  They do not have a lot of family activity, they do not have a lot of social activity, but they have a high number of specialists taking care of a high number of conditions.  If you have somebody with cancer and kidney problems and diabetes, they are really a complex case.  Those are most definitely the patients that you would want on a Chronic Care Management program!  

Besides just being able to manage them more effectively, it really gives that patient a true sense of being taken care of. But even beyond that, we have seen with these patients that are in those situations, they become very dependent on the nurse and the care manager to help them take care of these things.  It can become extremely complicated when you have so many complex issues. Not only is their situation extremely complicated to deal with, but sometimes they just don’t even know where to start, and especially if they are having to do it alone.  Those patients should definitely be among the highest of priorities to get enrolled in a Chronic Care Management program because, simply, they need somebody.  They need an advocate, somebody in their court.  They need a care management nurse to be able to help them handle the multitude of big issues that fill their plate.

Remember the first criteria for Chronic Care Management is that they have to have two or more chronic conditions that are expected to last at least 12 months or until the death of the patient.  You cannot forget that they have to have all of those conditions. That qualification has been set by Medicare. The reason it has been set is that it has been proven that when you have patients in these situations, they are more likely to have lower hospital costs and less stays in the hospital when the patient has someone they can depend on to help them with their health and wellness needs.  So, it is a huge advantage for patients to be able to be a part of a Chronic Care Management program.

Our third installment will cover the final Highest Risk category, plus a few notes about staff hiring, and how to get started. See you then!

Like what you read? If you're looking for help implementing Chronic Care Management at your practice, reach out to our team of experts!   

team cluster