Conditions That Qualify for Chronic Care Management
Chronic Care Management (CCM) is a Medicare program that helps patients with long-term health conditions better manage their care. Each patient is assigned a care coordinator who checks in at least once a month to:
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Set health goals
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Schedule appointments
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Remind patients about prescriptions
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Connect patients with community resources
Many providers are still unfamiliar with all the conditions that qualify for CCM. Below is a guide to the most common conditions that make patients eligible.
Eligibility for CCM
To qualify for Medicare’s CCM program, patients must have:
- Two or more chronic conditions expected to last at least 12 months
- Conditions that put them at risk of worsening or causing functional decline
The final decision always lies with the provider, who determines if the patient would benefit from CCM.
Blood and Cardiovascular Conditions
Patients with the following cardiovascular problems are eligible for CCM, however, these are not the only ones:- Hypertension
- Ischemic heart disease
- Congestive heart failure
- Anemia
- Atrial fibrillation
- Hyperlipidemia
- Diabetes
- Coronary artery disease
- Sick sinus syndrome
- Angina
- Sickle-cell disease
- Peripheral vascular disease (PVD)
Oncology and Cancer Conditions
Various chronic cancer types qualify for CCM which include:- Breast cancer
- Lung cancer
- Prostate cancer
- Colorectal cancer
- Leukemias and lymphomas
Bone, Joint or Muscle Conditions
Bone, joint, and muscle conditions that affect a person’s quality of life can qualify for CCM. Examples are:- Osteoporosis
- Rheumatoid arthritis/osteoarthritis
Eye Conditions
Additionally, eligible for CCM are conditions that impact a person’s vision, such as:- Cataracts
- Glaucoma
- Diabetic retinopathy
- Age-related macular degeneration
Additional Chronic Conditions that Qualify for CCM
Some other conditions affect different body parts and qualify for the CCM:Nephrology and Urology Conditions
Conditions that affect the bladder and kidneys include:- Chronic kidney disease
- Benign prostatic hyperplasia
- Kidney cysts
Neurological and Mental Health Conditions
Neurological and mental health issues cover a wide range of illnesses, including:- ADHD
- Alzheimer’s Disease and dementia
- Post-traumatic stress disorder (PTSD)
- Anxiety disorders
- Depressive disorders
- Autism
- Schizophrenia and other psychotic disorders
- Bipolar disorder
- Traumatic brain injury and nonpsychotic mental disorders due to brain damage
- Migraine and chronic headaches
- Cerebral palsy
- Epilepsy
- Parkinson’s
Gastroenterological Conditions
Some of the gastroenterological conditions that qualify for CCM are:- Irritable bowel syndrome
- Crohn’s disease
- Ulcerative colitis
Ear, Nose, and Throat Conditions
A variety of ENT conditions can benefit from CCM:- Sleep apnea
- Tinnitus
- Vertigo
- Conductive or sensorineural hearing loss
Respiratory Conditions
Medicare patients might face the following lung or respiratory conditions:- Asthma
- Chronic obstructive pulmonary disease (COPD)
- Emphysema
- Cystic fibrosis
Substance Use Disorders
Getting dependent on a substance makes a person have a substance use disorder. Those that can potentially qualify for CCM include:- Alcohol dependence disorders
- Opioid dependence disorders
- Nicotine dependence
- Other drug use disorders
Autoimmune Conditions
Any other physical condition that affects a person’s immunity and recovery from an injury or disease can attract the CCM program. These conditions include:- Human immunodeficiency virus and/or acquired immunodeficiency syndrome (HIV/AIDS)
- Viral hepatitis
- Multiple sclerosis
- Hypothyroidism
Bone, Joint, Spine or Muscle Conditions
These conditions affect the nervous system or bones, muscles, and joints. Examples are:- Spinal cord injury
- Spina bifida
- Muscular dystrophy
- Fibromyalgia
- Chronic pain
Other Disabling Conditions
Other conditions are disabling and might affect major life activities, so they could be eligible for CCM. These conditions include:- Developmental and learning disabilities
- Intellectual disabilities and related conditions
- Liver disease, cirrhosis, and other liver conditions
- Blindness and visual impairment
- Meniere’s disease and other sources of hearing loss
- Obesity
What to Expect when Patients Qualify for CCM
When patients qualify and agree to enroll in CCM, they receive:
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At least 20 minutes of care coordination each month (usually by phone, not face-to-face)
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Direct access to a care team member 24/7 in case of urgent issues
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A personalized care plan developed with their care coordinator
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Ongoing support such as appointment scheduling, medication refills, and closing care gaps
WellWink Health, LLC is a leading technology company that specializes in providing innovative solutions for the healthcare industry. With a dedicated focus on patient engagement and care coordination (CCM/RPM), our mission is to empower medical practices and healthcare facilities to deliver exceptional patient experiences and improve overall health outcomes.
To get in touch call us right now at (848)-291-2430 to learn more about our CCM program or you can also book a 30 min free consultation.
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