Chronic Care Management (CCM) makes proactive care profitable

Support your patients with consistent, high-quality care between visits. Phamily makes it fast and easy to get started.

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Between-visit care improves outcomes for patients with chronic conditions

Chronic Care Management (CCM) lets practices get fair compensation for this between-visit work. With Phamily, you can scale the same high-quality, consistent care to 10x more patients than traditional methods.

Reduced hospitalizations

Better self-management

Lower total cost of care

4 hours

to get everything up and running

90%

monthly patient engagement — averaging 3.4 times per month

$700K

annual revenue per 1,000 patients

50%

profit margin to reinvest in your practice

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Stop playing phone tag with your patients

Bring order to the chaos of ad hoc triage calls, medication refills, and chart updates. CCM gives medical practices a framework to operationalize between-visit care — and get paid for it.

Chronic Care Management (CCM) can transform your practice for the better

Deliver higher quality care

Streamline administrative tasks

Get fair compensation for between-visit work

Drive $700,000 annual revenue for every 1,000 patients enrolled

What is the difference between APCM vs. CCM?

Both Chronic Care Management and Advanced Primary Care Management compensate medical practices for between-visit work. Medicare uses these fee-for-service programs to reward providers who pursue value-based outcomes. However, there are important differences between the two programs, including which patients qualify and what activities are required to bill.

A businesswoman and a nurse smiling.

Launch your CCM program in just 4 hours

With Phamily’s industry-leading CCM platform and turnkey staffing, even the busiest practice can implement CCM, as onboarding takes just 4 hours. And for providers who prefer to keep things in-house, our AI copilot gives each care manager the tools they need to support 10x more patients with consistent, high-quality care.

Explore our CCM Resources

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CUSTOMER STORIES

KCCGA’s Strategy to Slow Chronic Kidney Disease Progression

After implementing initiatives to succeed in the value-based Kidney Care Choices model, the team at Kidney Care Center of Georgia (KCCGA) saw Chronic Care Management (CCM) as the next evolution to help patients under both fee-for-service and value-based models.

The Neurology Center’s “Easy” Path to Chronic Care Management

The Neurology Center operates without any clinical support staff, but a turnkey solution enabled them to quickly launch Phamily CCM for 650+ patients within the first 2.5 months — no hiring or training required.

Eastern Connecticut Hematology & Oncology

ECHO’s patients had diverse needs that required personalized care, but scaling between-visit care seemed impossible. A turnkey Connected Care service line helped them scale for better patient care and documentation.

DENT Neurologic Institute

DENT’s growing nursing team still couldn’t keep up with patient needs between visits, until they started texting through Phamily Connected Care.

Chronic Care Management for Oncology

Cancer patients need significant care and support between visits. Oncology providers may balk at implementing Chronic Care Management (CCM): too expensive, for too few patients. But innovative cancer centers with Integra Connect are scaling high-quality, profitable CCM programs across 1000s of patients — and seeing transformative outcomes.

Empower Your Oncology Patients – and Practice – with Chronic Care Management

The ECHO team, led by Dr. Kapur, explain how they launched their Chronic Care Management program, share the positive impact CCM has had on their oncology patients and practice, and answer questions from a live audience.

Nephrology Associates of Kentuckiana​

Ramsay Nassar, MD sees increased prescription compliance, reduced hospitalization, and higher overall engagement from his practice’s CCM program.
How did Dent Neurologic Institute Launch a CCM Program?

Dent Live Q&A

Katie Ross, the Director of Clinic Operations at DENT Neurologic Institute, took questions from other neurology practice leaders about how DENT launched their Chronic Care Management (CCM) program with Phamily.

Balancing Kidney Care​

Jennifer Huneycutt, CPA, CMPE explains how to match patients to programs for success in FFS and VBC.

TOOLKITS, WHITEPAPERS, AND ARTICLES

How to benchmark your Chronic Care Management (CCM) program

Less than 3% of providers participate in Medicare’s Chronic Care Management (CCM) program — even though Medicare increased reimbursement by 54% in 2022. CCM compensates providers for all the between-visit care they currently provide for free to their patients with multiple chronic conditions. So why don’t more providers run CCM programs? It’s a question of scale...
Top trends from the NeuroNet Summit 2024

Neurologists have practice management on the brain (sorry, we had to)

Coming out of the NeuroNet Summit 2024 last week, one thing is clear: neurology leaders are actively seeking solutions to the industry-wide challenges putting their practices at risk...

Are these 3 barriers keeping you from delivering better between-visit care?

Chronic Care Management can help medical groups deliver better care while creating a durable and profitable revenue stream — here’s how to overcome the most common barriers...
Less than 1% of neurologists are compensated for between-visit care under the Medicare Chronic Care Management (CCM) program - let's fix that!

Chronic Care Management (CCM) For Neurology

Neurologists provide extensive between-visit care to their patients with chronic conditions – but only 0.37% are earning fair compensation for that care through Medicare’s Chronic Care Management (CCM) Program...

Combating Margin Compression

How wilI your practice beat margin compression? Experts at Pinnacle and Phamily will help you understand margin pressures and identify, prioritize, and invest in margin expansion opportunities that can enhance your profitability in 2024 and beyond.

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Talk to us

Whether you want to learn more about Chronic Care Management (CCM), understand staffing options, or demo the Phamily platform, our experts are here to help.  

Are you a patient? Click here to learn about Phamily for patients.

Consistent care, fewer calls

Replace hundreds of monthly phone calls with weekly personalized text check-ins that patients love.

Work smarter, not harder

Headache-free auto-documenting care management, smart care plan templates and follow-up protocols.

CCM at significant scale

Enroll 1,000+ patients in 60 days. Not a dead-end side project that goes nowhere fast.