Chronic Care Management (CCM) Services
HealthXL® delivers easily-implemented Chronic Care Management services to improve care for Medicare patients with two or more chronic conditions. By combining consistent virtual monitoring, follow-up and accountability, our Chronic Care Management services are proven to improve patient care, streamline the healthcare process and boost practice revenue.
A Better Way to Care
Elderly persons suffering from chronic health concerns often have complex treatment requirements. That’s why they require a better, more comprehensive care model. Since CCM launched in 2015, it’s been our mission to provide that through patient-centered, practice-friendly services with empathy and efficiency. Beginning as one of the pioneers in Chronic Care Management, we are now the leader in the industry.
By focusing on improved communication, coordination and support, we help both patients and practices benefit. Our services decrease patient visits to hospitals, emergency rooms and doctors’ offices, and lower healthcare expenses while improving the quality and coordination of patient care.
What is Chronic Care Management?
Chronic Care Management is the virtual monitoring and support of Medicare beneficiaries who have multiple (two or more) chronic health conditions. CCM ranges from accountability to care coordination and support, benefiting both the patient and provider.
20 minutes of remote clinical support every month by highly qualified Care Coordinators
Performed as a complement to regular office visits, reducing unnecessary patient appointments
Guidance and encouragement to follow a provider’s prescribed plan of care
Medicare defines patients eligible for Chronic Care Management as having two or more chronic conditions that are expected to last at least one year. These include but are not limited to: hypertension, heart disease, COPD and diabetes.
Chronic Care Management Services
for Healthcare Providers
HealthXL®‘s Chronic Care Management services for healthcare providers help you seamlessly extend your practice to enhance your quality of care.
Your patients enjoy better health guidance and access to your practice while your practice benefits from an additional revenue stream–all at no cost to you.
Chronic Care Management started in earnest when the Centers for Medicare and Medicaid Services (CMS) introduced a new Medicare billing code (CPT 99490) in 2015 to compensate providers for non-face-to-face care coordination for patients with two or more chronic conditions.
Nearly 70% of the 67.7 million Medicare patients in 2020 are challenged with two or more chronic conditions. However, most healthcare providers don’t have the capacity or infrastructure to give them the help and attention they need on a monthly basis. Our better way to care offers a simple and profitable solution.
- Enhanced monitoring and coordination of care between office visits
- Enriched patient-practice relationships
- Increased monthly office revenue and profitability
- Improved access for patients while eliminating unnecessary ED visits and hospitalizations
- Streamlined, accelerated and consistent patient enrollment
- Peace of mind in the event of a CMS audit
Enroll More Patients
Streamlined and accelerated patient enrollment is at the core of the success of our Chronic Care Management programs for healthcare providers. HealthXL® has designed patient enrollment programs that reduce education time for practices and reassure patients about the program’s value–all while ensuring program compliance.
The average in-house enrollment program enrolls only 10% of eligible patients. However, HealthXL®‘s Accelerated Enrollment Program typically achieves enrollment rates of up to 50% for our initial enrollment campaigns.
- Identification of Eligible Patients: Our data team will access your Electronic Medical Records (EMR) and identify eligible patients
- Enrollment Calls: Our specialized enrollment team will contact patients, educating and enrolling those who consent
- Documentation: We document patient consent in your EMR and provide you with reports on results
- Updates: We review your ever-changing patient population on a regular cadence to ensure all eligible patients are given an opportunity to join the program
Service Systematically
Consistent monthly services are essential for the effectiveness of your CCM program. HealthXL®’s proven Chronic Care Management services help practices deliver high quality care at scale by leveraging the latest technology and high-quality clinician training and management.
Consistent Care: Our system-driven, workflow-based model ensures that each patient receives the same thorough care regardless of assigned care coordinator
Dedicated Care Team: Our dedicated Care Coordinators are highly skilled at delivering Virtual Care Services and are undistracted by competing office responsibilities like an in-house team would be
Simple to access: Our work integrates seamlessly into your practice workflow. There’s no need for you or your patients to learn a new platform. Simply access the latest patient care plans through your existing EMR using a secure link or PDF
Service With Quality
HealthXL®’s Patient-Centered Care Coordinators spend every day focused on helping your patients succeed in their health objectives, answering their questions, and connecting them to healthcare resources.
Convenient: Patients receive monthly contact from their Care Coordinator at a convenient time, in the comfort of their home. We’ll make multiple attempts to speak to your patients each month
Proactive: Care Coordinators are equipped with questions specifically targeted to a patient’s specific conditions that seek to identify problems early, preventing unnecessary and costly hospital visits
Empathetic: We train Care Coordinators specifically for intentional listening, responsiveness, and compassion. Our goal is to treat each patient as we would want our loved ones treated. Each Care Coordinator is evaluated by this standard in our quality assurance audits
Effective: HealthXL®’s monthly contact results in maximized patient adherence to their care plans and provider-prescribed treatments
Improve Profit Margins
Our Chronic Care Management services for healthcare providers are proven to provide new, meaningful, recurring revenue to a practice. The national monthly average reimbursement of $41 from CPT code 99490 can significantly improve your profit margins with no financial risk to you.
500 Enrolled Patients = $85,000 potential increase in profit per year
1,000 Enrolled Patients = $170,000
5,000 Enrolled Patients = $850,000
Large healthcare systems can realize profit margins measured in millions
Protected Against CMS Audits
We mitigate the risks of CMS audits, with meticulous time tracking, documentation and reporting, ensuring all services are fully compliant.
Time tracking, by activity, down to the second
Monthly activity and care plan update documentation in your EMR system
Patient eligibility validation and HIPAA compliance
Chronic Care Management Services
for Patients
HealthXL®‘s Chronic Care Management services provide consistent, ongoing care for those suffering from complex, chronic health concerns. We recognize that personally coordinating multiple healthcare providers, labs, testing facilities and other caregivers can be time consuming, complex and unnerving. We make it simple by putting everyone on the same page. With the help of a dedicated Care Coordinator, patients receive the help they need to manage their health.
Benefits of Chronic Care Management for Patients
Get Everyone on the Same Page
Managing chronic conditions is a team effort, from physician to the patient and their family. Our Care Coordinators make life easier by getting everyone on the same page. That means regularly checking in, answering questions, coordinating activities, tracking down medical records, and improving lines of communication to ensure patients are receiving the best possible care.
Stay Connected
Each month, patients receive a call from their Care Coordinator to check on their health and see if there’s anything they need. Their Care Coordinator will ask questions focused on their unique conditions, aimed at identifying any concerning changes in their health and giving their provider a monthly report. Patients can access their comprehensive care plan through their provider’s portal 24/7.
Improve Patient Health
Chronic Care Management is proven to help patients follow their provider’s care recommendations, improve their overall health and reduce their need for office, ED and hospital visits. With monthly guidance from their Care Coordinator, they receive the encouragement and resources they need to stay healthy.
Chronic Care Management Services
for Healthcare Systems
Our Chronic Care Management services for health care systems are designed to deliver high-quality, secure and compliant care management services at scale while extending the reach of your physicians and facilities.
We help patients with chronic conditions stay proactively engaged in their own care, reducing unnecessary provider, ED and hospital visits. All without placing any incremental burden on your resources.
- No new software or hardware required
We employ and manage all clinical Care Coordinators
No upfront or recurring costs
Near 100% monthly patient service rate
Work within and as a complement to your existing EMR
Reduce Healthcare Costs
With the nation’s aging population on the rise (10,000 people turning 65 each day), chronically ill patients are accounting for a majority of all emergency room visits, many of which are preventable. Our services work to reduce those visits by providing accountable, high-quality, preventive care. According to CMS, CCM is “increasing patient and practitioner satisfaction, saving costs…” However, CCM “continues to be underutilized.”
Chronic Care Management Services
for Healthcare Partners
HealthXL® is experienced at working with third party medical device and software resellers and their provider clients. As the industry leader, we’ve been providing Chronic Care Management Services since its inception in 2015.
HealthXL® provides the following advantages for third-party partners:
- End-to-end CCM services that expand your clients’ healthcare team with no upfront costs and minimal time investment
- Accelerated Enrollment Program that educates patients on the benefits of Chronic Care Management
- Incremental revenue that improves profits for you and your clients
Services tailored to practice workflows and existing EMRs
Why Partner With HealthXL® to Be Your
Chronic Care Management Company?
We improve patient care, deepen patient-practice relationships and increase practice revenue without adding cost. If you’re interested, contact us today. Our programs can be set up and running in just a few weeks.
ZERO UPFRONT COSTS
There are no hidden fees or ongoing costs to your practice for enrolling your patients in the program.
STREAMLINED TECH SOLUTIONS
HealthXL® works within your current EMR software. No need for software or hardware purchases or training of your staff on new systems
TRAINING AND RESOURCES
Since our Care Coordinators are our employees, we handle all hiring, onboarding, training and management – a turnkey solution every step of the way.
ACCELERATED ENROLLMENT
Our CCM user interface is a faster, proven way to drive patient participation – and retention.
INCREMENTAL REVENUE
When properly utilized, RPM is highly profitable through Medicare reimbursement.
COMPLIANCE CONFIDENCE
Medicare and HIPAA guidelines are always evolving. You can trust HealthXL® to keep you up to date on the latest guidelines and ensure that your service is fully compliant
CUSTOMIZED WORKFLOW
HealthXL®’s proprietary software, iCare by HealthXL®, is workflow-based, ensuring all patients are serviced consistently, thoroughly and securely regardless of assigned Care Coordinator. A physician’s general or patient-specific instructions can be included with confidence

Fully Compatible With
Existing EMRs
Our Remote Patient Monitoring services work side by side with current Electronic Medical Records (EMR) software. Seamless workflow integration means not having to learn another technology or invest in new methodology. Simply access patient care plans through your existing EMR using a secure link or PDF.
We currently work with the following EMR platforms and are always expanding: