Implementing Care Management Programs: A Physician's Practical Guide

As a practicing physician, you know your complex patients need more than 15-minute office visits can provide. Care management programs offer a solution—but implementation can seem daunting. This practical guide will help you get started. Understanding the Programs: 1. Chronic Care Management (CCM) For patients with 2+ chronic conditions. Provides 20 minutes monthly of non-face-to-face care coordination. Medicare pays approximately $42-70 per patient per month. 2. Principal Care Management (PCM) For single high-risk conditions (CHF, diabetes, COPD). More intensive than CCM with 30 minutes monthly. Medicare pays approximately $58-90 per patient per month. 3. Remote Physiological Monitoring (RPM) 24/7 monitoring of vitals through connected devices. Captures both device supply and monitoring time. Medicare pays approximately $110-160 per patient per month. 4. Collaborative Care Management (CoCM) Integrated behavioral health for depression, anxiety, and other mental health conditions. Provides psychiatric consultation and care management. Medicare pays approximately $130-200 per patient per month. The Implementation Challenge: Most practices struggle because they: - Lack dedicated staff for care management - Don't have the technology infrastructure - Can't afford the upfront investment - Fear disrupting existing workflows The Turnkey Solution: Partnering with an external care management organization like MyBr Health addresses all these barriers: ✓ Pre-trained Care Management Staff No need to hire, train, or manage care managers. We provide RNs, LCSWs, and CHWs dedicated to your patients. ✓ Complete Technology Platform EHR integration, patient engagement apps, and reporting dashboards included. We handle the IT complexity. ✓ Zero Upfront Investment No capital expenditure. We operate on a revenue-share model—you only benefit when patients are successfully enrolled. ✓ Minimal Workflow Disruption Monthly care plan review (10-15 minutes per patient). You maintain clinical oversight without daily operational burden. Implementation Timeline: Week 1-2: Discovery - EHR integration setup - Identify eligible patient population - Staff training (typically 1-2 hours) Week 3-4: Pilot Launch - Enroll first 20-30 patients - Care team begins outreach - Refine workflows based on feedback Week 5-8: Scale - Expand to broader patient population - Monthly outcome reviews - Optimize based on results Expected Outcomes: Based on our partner practices: - 30-50% reduction in hospital readmissions - 15-25% improvement in HEDIS measures - 95%+ patient satisfaction - $50K-200K annual program revenue (depending on practice size) Common Concerns Addressed: "Will patients accept calls from non-physicians?" Yes. Patients appreciate dedicated attention. Care managers explain they're working with your direction. "What if I disagree with a care plan?" You maintain 100% clinical authority. Care plans are recommendations for your review and approval. "Can we start small?" Absolutely. Most practices start with 20-30 highest-risk patients, then expand. "What about liability?" Care management operates under your clinical supervision. Standard malpractice coverage applies. We maintain our own professional liability insurance. Getting Started: 1. Identify your 50 highest-risk patients 2. Schedule a demo with a care management partner 3. Review financial projections and patient selection 4. Sign partnership agreement 5. Begin pilot enrollment The Bottom Line: Care management programs aren't a luxury—they're essential for providing high-quality care to complex patients. The question isn't whether to implement them, but how to do so efficiently. Partnering with an established care management organization allows you to provide exceptional care coordination without the operational headache. Your complex patients get the support they desperately need, and your practice becomes more sustainable. Want to learn more? Contact us to schedule a demo and see how care management can transform your practice.