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.

The average median program size is tiny at just 41 patients per provider. At that scale, the operational costs outweigh the potential upside. To be financially sustainable, programs need to reach critical mass in a cost-effective way – quickly. But what does that actually look like?

Under-penetration of the CCM program means that many medical group leaders have not seen a cost-effective CCM program operating at full scale. Without that exposure, it may be difficult to evaluate the performance of your own CCM program. Here are some benchmarks that may be useful.

Benchmarks for a scalable, profitable Chronic Care Management (CCM) program

Three types of benchmarks can help you evaluate your program:

  1. How quickly can you scale up to a critical mass?
  2. How well are you engaging your patients?
  3. How much value are you adding to your practice?

Speed to scale

You can start seeing program revenue in 90 days with a strong launch. Here are three key benchmarks to consider:

  • 30 days until enrollment. Can you stand up staffing, workflows, and a process to get started with enrollment in 30 days?
  • 30% enrollment within 1 year. If you have 10,000 eligible patients, you should have 3,000 enrolled within a year of starting your program. This predictable pipeline will allow you to grow the program on your terms: you can use program revenues to invest in additional care managers, knowing that for every 1000 eligible patients, you will successfully enroll 30-40%.. 
  • 1 FTE : 500 patients. For the program to be financially sustainable, you need to equip a care manager to handle a panel of roughly 500 patients. Under a labor-intensive traditional approach to care management, you may only be able to achieve a ratio of 1 care manager to 50-100 patients. (This is why the median program size is so small.) Augment your EHR with purpose-built technology to help your care managers engage effectively with their patients and streamline administrative work.

Patient engagement and patient satisfaction

It’s not enough to simply operate at scale. Clinical outcomes and patient satisfaction should be top of mind. Your most valuable assets are the relationships you have with your patients. Does your patient engagement reflect that?

  • 70% or more of your patients engage each month. Care managers need patients to engage on a regular basis in order to proactively follow up with them and help them be compliant with their care plans. Regular engagement gives care managers a real-time pulse on how their patients are doing for early detection and intervention on clinical issues. Without regular patient engagement, you won’t see clinical outcomes. 
  • Patients engage 3+ times per month. Your patients need to develop relationships with their care managers through accessible, continuous dialogue so that they feel comfortable sharing information about their symptoms and asking for help. A rote phone call one time per month isn’t enough to build a trusted relationship. 
  • 9/10 or higher patient satisfaction score. Is your staff overwhelmed? Do your patients struggle to get in touch on the phone when they need help? Are portal messages piling up? Creating a pathway for patients with complex needs to get help quickly can significantly improve patient satisfaction.

Profit and value

An efficient, effective, scalable care management program can drive financial success under both fee-for-service and value-based payment models. 

  • 40% profit margin. If you are doing Medicare CCM, you should be achieving around a 40% profit margin. This monthly cash flow infusion can help you invest in additional staff to grow your CCM program while providing the stability you need as you move into at-risk value-based models.
  • $175,000 annual profit per 1000 patients. When you operate efficiently, two care management FTEs can serve 1000 patients and drive substantial profit. Not only do the care managers pay for themselves – they provide extra funds for you to reinvest in your practice. 
  • $1400 cost reduction PMPY. For patients with 2+ chronic conditions, care management can substantially drive down Total Cost of Care via a shift from inpatient to outpatient utilization and a shorter average length of stay. The ability to move the needle on utilization is critical for success in value-based contracts where your medical group is on the hook for total cost.

Why don’t most CCM programs meet these benchmarks?

Most medical groups have a large pool of Medicare patients with 2+ chronic conditions, but a limited ability to impact those patients with care management. Traditional care management involves a care manager calling an average of three times before reaching them on the phone, then spending 20 minutes after the call trying to complete documentation in the EHR. 

Besides offering a suboptimal approach to patient engagement, traditional care management is labor-intensive and extremely expensive. Medical groups simply don’t have the staffing or the funding to provide traditional care management to all of their patients who could benefit.

The care management model of the future - now.

Traditionally, care management has been a limited resource. Staffing shortages stifled program growth, and medical groups were left with small-scale, unprofitable programs. 

But now, care managers now have access to technology that can significantly streamline their work and improve their ability to care for patients. In the future, we need to think of care management as a population-scale capability. We’ll talk more about that next week – but in the interim, please connect with me if you’d like to learn more.

Chief Revenue Officer

Darshan has 15+ years experience co-founding and building high growth healthcare technology businesses committed to improving access to care and quality of care. More about Darshan…