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To qualify for CCM services, individuals must be enrolled in Medicare and live with two or more chronic conditions such as arthritis, diabetes, heart disease, high cholesterol, high blood pressure, and others. These conditions typically require ongoing management and care.

CCM services involve the provision of care management by a dedicated Registered Nurse (RN) case manager. This RN serves as a central point of contact for the patient, helping to coordinate care across various healthcare providers, specialists, testing centers, hospitals, and pharmacies.

CCM services require a minimum of 20 minutes per month spent by the RN case manager with the patient. During this time, the RN assesses the patient's health status, reviews their medications, educates them on self-management strategies, and develops a personalized care plan.

The primary focus of CCM is to ensure seamless coordination of care among different healthcare providers and settings. The RN case manager communicates with the patient's primary care physician and specialists to ensure that all aspects of the patient's care are well-coordinated and aligned with their individual needs and preferences.

CCM empowers patients to take an active role in managing their chronic conditions by providing them with the necessary support, resources, and information. The RN case manager works collaboratively with the patient to set health goals, track progress, and address any barriers to care.