Chronic diseases, such as diabetes, heart disease, and hypertension, have been on the rise globally, largely attributed to aging populations, sedentary lifestyles, poor dietary habits, and other risk factors. Chronic conditions often require long-term management, involving regular appointments, medication adherence, lifestyle modifications, and coordination among healthcare providers. Based on this, the fragmented nature of healthcare delivery systems and limited time during physician visits can make it challenging for patients to receive the comprehensive care they need.

Chronic Care Management (CCM) companies have emerged as a solution to bridge the gap between healthcare providers and patients with chronic conditions. These companies leverage technology to provide comprehensive care coordination and support to individuals with chronic illnesses. Through seamless communication and collaboration among care teams, chronic care management software and programs reduce the risk of fragmented care,  prevent medical errors and delayed diagnoses, and help patients navigate the complexities of their conditions and achieve better patient outcomes.

In this guide, we will take a closer look at some of the top CCM companies in 2024 that are helping reduce the overall healthcare cost burden and improving the quality and delivery of care to patients with chronic illnesses.

HealthSnap Chronic Care Management Software and Remote Patient Monitoring

HealthSnap is a prominent player in the field of chronic care management (CCM) and has been instrumental in advancing the role of technology in care coordination and improving patient outcomes. With its innovative virtual care platform and support services, HealthSnap has emerged as a leader in facilitating effective chronic care management.

The HealthSnap platform supports care coordination among various healthcare providers involved in a patient’s treatment. Combined with its cellular-enabled industry-leading Remote Patient Monitoring (RPM) program, the company plays a pivotal role in optimizing chronic care management. The HealthSnap CCM platform enables patients to take an active role in their health, provides healthcare providers with valuable data in near real-time for faster decision-making, and ultimately leads to better patient outcomes and reduced healthcare costs.

HealthSnap is revolutionizing the way chronic care is delivered, empowering patients, improving the continuity of care, and driving better health outcomes. The advantages of choosing HealthSnap as a partner in chronic care management include:

For Patients

 HealthSnap’s medical record integrated CCM software is proven to improve outcomes for each patient with a patient centered care plan:

• 83% of all patients lowered their blood pressure after 90 days

• The average change in systolic blood pressure – 9.3 mmHg

• The average change in diastolic blood pressure – 5.4 mmHg

• Average weight change across all weight monitoring patients – 5 lbs

• Number of patients that showed improved health outcomes – 70 %

• Number of patients that say they have an improved sense of security since being monitored – 93%

• Number of patients that say they have an improved sense of control over their health – 93%

• Number of patients that say HealthSnap consultations help them understand their health – 82%

• Number of patients that say they have made large lifestyle changes – 73%

For Health Care Providers

• HealthSnap’s single integrated virtual care platform simplifies the management of chronic conditions by helping monitor chronic conditions at scale. HealthSnap’s platform helps drive proactive and continuous patient care through seamless coordination among providers, care teams, and administrators.

• Care coordination at scale becomes more secure with HealthSnap’s HITRUST-certified, HIPAA-compliant, and interoperable solution, which ensures security, reliability, and compliance.

• Healthcare providers have an opportunity to diversify their revenue streams by utilizing HealthSnap’s CCM software, helping them generate up to $1,883 in new revenue per patient per year.

• CCM software with patented medical billing reports and CCM time tracking for each CCM CPT code such as CPT code 99490 and CPT code 99439.

For Provider Groups

By harnessing the power of HealthSnap’s CCM software and co-sourced care coordination, provider groups and private medical practices can manage chronic conditions more effectively across high-risk chronic populations and throughout the patient care continuum. Some of the key features of HealthSnap’s CCM virtual care platform for provider groups include:

• Dedicated patient enrollment teams

• Patient-centered care plan builders

• CCM CPT code time tracking

• Patented CCM billing automation

• Clinical and non-clinical patient support

For Health Systems

HealthSnap’s virtual care platform for chronic disease management is built for the enterprise, bringing care teams together to deliver, proactive, continuous, and remote patient care in near real-time. Health Systems can improve patient outcomes, reduce utilization and boost revenues on a sustainable basis. Some of the highlights of the HealthSnap CCM platform include:

• HITRUST certified

• Acute and ambulatory EHR integration supported

• Customizable workflow and task automation

• Population health analytics

• White-labeled

For ACOs and IDNs

 Designed for the outcomes-focused, data-driven, and value-based healthcare organization of the future, HealthSnap is helping ACOs and IDNs deliver the quadruple aim with integrated virtual care. With this CCM platform, value-based provider organizations can more effectively prioritize the sickest patients (who will benefit the most from proactive care). It helps reduce the overall cost of care, promotes continuity of care at home post-discharge, and ensures patients in-network stay in-network. Highlights include: 

• Enterprise data warehouse integration

• Remote Care Navigator (RCN) certification

• Customizable patient education and care coordination

For FQHCs, CHCs, and Rural Health Clinics

HealthSnap offers a single, unifying place for the whole care team to do their best work, enabling healthcare organizations to move from reactive, episodic care to proactive and ongoing care delivered in the home. At the same time, it helps increase access to care for rural and underserved populations. With HealthSnap for FQHCs, health access, and equity becomes a reality for everyone. Key features include:

• Multi-language patient support

• Supports HRSA and FCC Telehealth grant awards

• Rural RPM via 4G LTE and remote enrollment

ChartSpan

With its comprehensive suite of services and cutting-edge technology, ChartSpan has emerged as one of the top facilitators of effective chronic care management. With ChartSpan’s CCM program, healthcare organizations can provide patients with round-the-clock access to care management, while tapping into new recurring revenue streams.

ChartSpan’s qualified care team reaches out to the enrolled patients telephonically every month, focusing on individuals with multiple chronic illnesses who require extra attention and support. The company acts as an extension of the provider’s care coordination teams, ensuring that patients with chronic conditions have continuous access to a clinical professional.

By partnering with ChartSpan, healthcare providers can free up the time of their staff to focus more on providing in-person care. Some of the services ChartSpan provides include:

•  Medication refill assistance

• Support in meeting the healthcare goals set by you

• Support with mobility and transportation needs

• Help in scheduling specialist or physician appointments

• Support for family members and caregivers

• Assistance with X-rays, lab tests patient records, and reports

• Continuous development of individual care plans

• Support with Social Determinants of Health

For Providers

ChartSpan’s proprietary CCM software enables its care team to easily track time spent together, document interactions, review patient status, and report progress back to the provider each month. Benefits for providers include:

• Revenue: Gain a new stream of monthly recurring revenue.

• Attribution: Medicare patients remain attributed to your practice.

• Quality: Closed care gaps lead to improved Quality scores.

• Outcomes: CCM is proven to improve patient outcomes.

For Patients

ChartSpan’s 24/7 nurse line is always available to address patients’ questions, needs, and concerns. Benefits for patients include:

• Coordination: Ensure coordinated care with the patient-centered care plan’s other providers.

• Support: Access our nurse line for round-the-clock support.

• Savings: CCM patients save on average $240 per year and experience 20% fewer hospitalizations.

• Planning: Ensure that patients follow the recommended care plans and goals.

Signallamp

Signallamp ranks among the preferred chronic care management companies for leading health systems in the United States. They specialize in partnering with primary care practices to serve as their remote care department, handling all the necessary tasks to keep chronic disease patients healthy and minimize emergency room visits between office appointments.

Rather than replace the existing CCM programs of large health systems and other healthcare providers, Signallamp’s platform and personalized nurse care management model augment and enhance existing programs, enabling the providers to achieve scalability that would otherwise be challenging.

Key advantages of Signallamp’s CCM services include: 

• Dedicated Nurses: Signallamp utilizes dedicated nurses instead of call centers. These nurses work with the same patient panel and care team consistently, establishing trusted relationships with patients.

• EHR Workflow: Signallamp’s nurses document directly within your EHR workflow, ensuring efficient collaboration with your care teams.

• Patient Retention: Signallamp’s personalized approach to chronic care management services enhances patient satisfaction and retention and fosters continuity of care, contributing to long-term scalability and profitability.

• Nurse Recruitment and Training: Signallamp handles the recruitment, hiring, onboarding, and training of nurses to ensure a seamless process for their health system clients.

• IT Connectivity: Signallamp combines its advanced IT connectivity with its personalized care model, delivering a chronic care management service platform that supports the sustainable scaling of remote chronic care programs.

• Patient Enrollment: As a top chronic care management company, Signallamp emphasizes informed enrollment consent from each patient. Their enrollment team meticulously scripts and documents each enrollment, providing an enrollment confirmation letter to patients to ensure transparency and compliance.

• Productivity at Scale: Backed by Signallamp’s efficient infrastructure and established workflows, their team works in the background to maximize productivity.

Engooden Health

Engooden Health is helping transform the chronic care management (CCM) model, aiming to establish consistent, timely, and trust-based patient engagement between physician visits. The company’s technology-driven services enable care navigators to identify and address obstacles to care between provider visits, allowing patients to effectively prioritize their health.

The company’s approach focuses specifically on high-risk patients living with chronic conditions, a significant population that is often challenging to reach. Engooden Health aims to alter the course of and improve patient health outcomes, ultimately enhancing the overall quality of life.

Reliable Technology

The company utilizes proprietary technology, certified by HITRUST, which continuously analyzes electronic health records (EHRs) to identify patients eligible for chronic care management. Automated medical billing that is seamlessly integrated with popular providers’ EHR systems such as Athena, Epic, Cerner, and others. Engooden Health stands out by identifying more care gaps and, consequently, more patients.

Engooden Health’s technology-driven workflows offer medical practitioners an effective and scalable approach to chronic care delivery. Equipped with the necessary tools, care navigators allocate more quality time to a greater number of patients on behalf of physician practices, assisting patients in achieving their healthcare goals and improving their quality of life.

Personalized Services

Engooden care navigators establish enduring relationships with patients through regular and direct outreach. These care navigators build a level of trust and emotional connection that enables them to identify care gaps, insights, and intervention opportunities that may be challenging to uncover during brief office visits.

• Care navigators engage with patients at least once every month to conduct condition-specific risk assessments, address episodic care gaps, serve as care plan coaches, and remove both clinical and non-clinical barriers to health.

• Leveraging technology, care navigators efficiently spend more time with a higher number of patients each month, effectively scaling chronic care management programs.

• Engooden Health takes on the risk and staffing burden to scale each customer’s custom program, including the vital task of educating physicians and office staff.

Optimize Health

The remote care platform developed by Optimize Health offers healthcare providers a unified interface to enroll and care for patients through Remote Patient Monitoring, chronic care management, and principal care management.

Supported by a top technology team, including trained former medical professionals and advisors, Optimize Health prioritizes the patient experience and utilizes technology to enhance the quantity and quality of patient interactions. The company’s expertise empowers provider groups to establish and expand remote care programs that lead to improved patient outcomes, reduced healthcare costs, and stronger patient-provider relationships.

Optimize Health’s platform enables the delivery of a patient-centered continuum of care. It grants providers the flexibility to manage patients remotely while offering personalized and precise care at scale.

Key Features of the Optimize Health Platform

• Personalized Patient Care: Personalized patient care plans for chronic care management (CCM) are tailored to specific conditions, encompassing goals, barriers, symptoms, problems, medications, and allergies.

• Care Plan Management: Care plan management with automatic time tracking for CCM to avoid duplications, easy enrollment and treatment of patients across various care programs, the ability to share care plans with other providers and clinical teams, and direct communication with patients and their friends, family, and caregivers through text or calls, all within the platform.

• Advanced Task Management: Advanced task management consolidates all patient-related tasks in one place, including medication management, coordination and communication among providers, and the ability to perform bulk actions across multiple patients simultaneously.

TimeDoc Health

TimeDoc Health supports healthcare organizations in delivering care management programs at scale, adhering to best practices, and leveraging proven technology. The company has developed top-tier solutions specifically designed for integrated, virtual care. The care management solutions and services provided by TimeDoc were created by physicians with the intention of seamless integration into the organization’s Electronic Health Record (EHR) system and workflow.

How TimeDoc Supports Chronic Care Management

Staff Augmentation: When it comes to chronic care management, many healthcare organizations face limitations in their capacity to provide virtual care. TimeDoc offers a team of medically trained care managers who can serve as a remote extension of the organization’s practice, facilitating care coordination.

Enrollment Services: TimeDoc’s enrollment services assist in identifying the most suitable patients for the Chronic Care Management (CCM) program and work towards increasing enrollment through direct patient engagement. These services handle patient education, obtaining consent, and sending out care plans, ensuring compliance with Medicare regulations.

Maintain Medicare Program Compliance: The platform stores monthly encounter summaries, patient consent, medical records, and care plans for easy access, and pushes PDFs into the organization’s EHR system, providing support in case of a Medicare audit.

Automate Care Planning: TimeDoc’s platform allows users to utilize pre-established care plans developed by physicians or create custom templates. These plans can be uploaded and synchronized with the organization’s EHR system, automatically populating patient data and streamlining the care planning process.

Reduce Documentation and Billing Time: Through advanced, EHR software integration, healthcare professionals can directly document patient information from the chart, simplifying end-of-month CCM billing. The system generates reports that automatically calculate charges based on documented activities, reducing documentation and billing time.

 Increase Care Staff Efficiency: TimeDoc’s dashboards offer real-time visibility into program size, patient population, and care management productivity. Care teams can prioritize their patient panel based on risk level, minutes documented, active problems, and other relevant factors, enhancing care staff efficiency.

ChronicCareIQ

ChronicCareIQ’s mission revolves around alleviating the daily suffering experienced by millions of chronically ill and medically fragile patients. The company achieves this by constantly innovating new methods for patients to communicate relevant information to their doctors between visits.

Their enterprise-ready technology provides a comprehensive software solution that allows healthcare staff to establish effective care management programs without relying on costly third parties. ChronicCareIQ operates on a transparent pricing model, offering its services for a fixed monthly price. 

Numerous medical practices rely on ChronicCareIQ to automatically capture and document the ongoing efforts they invest in caring for their chronically ill patients. This streamlined approach leads to improved health outcomes for chronic care patients and enhanced financial outcomes for the practices.

Enhancing Care Quality and Connectivity for Chronically Ill Patients

ChronicCareIQ’s acclaimed technology solution takes a proactive approach by engaging eligible patients and obtaining updates on their current health status. Through a user-friendly dashboard, staff members receive alerts regarding patients who are trending poorly or require outreach, enabling them to prevent adverse events.

Additionally, ChronicCareIQ seamlessly integrates with the organization’s Electronic Health Record (EHR) and phone system. This integration ensures that all eligible activities and patient interactions are automatically captured in electronic medical records, timestamped, and properly documented with the appropriate reimbursement codes for Chronic Care Management (CCM).

The result is a combination of improved patient outcomes, more accurate documentation, and secure reimbursements for healthcare providers.

HealthSnap: The Best CCM Company Improving Patient Outcomes

The growing role of Chronic Care Management software companies represents a significant shift toward patient-centered, comprehensive care for individuals with chronic conditions. On most of the key metrics to assess the capability and performance of a CCM company, HealthSnap comes out on top among various leading CCM service providers. 

Over the last seven years, HealthSnap has emerged as an industry leader in Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) technology and services. HealthSnap is more than just an integrated virtual care platform– we’re a true solution to bring a higher quality of life to people with chronic conditions and their care teams.

Let’s start a conversation about how our all-in-one integrated Virtual Care Platform can help drive your virtual chronic condition management programs. Call today at 888-780-1872 or click here to schedule a demo.