Chronic Care Management Solution


Chronic Care Management Solution

When tending to patients with chronic disease, it’s vital that you have a reliable chronic care management (CCM) solution in place to ensure that provider teams can deliver the most streamlined patient care. CCM services are essential for sharing patient information, promoting smoother care transitions and monitoring medications while building your facility’s revenue, enhancing Medicare compliance and ultimately optimizing your care management systems.


At TimeDoc Health, we provide medical facilities with non-complex chronic care management platforms that integrate directly into their electronic health records (EHR). Through our CCM services, we enable users to refer to our care management team as an extension of their staff to provide the functional and efficient care coordination they need.

What Is Chronic Care Management?

Chronic care management refers to the ongoing patient care medical professionals deliver to individuals with two or more chronic illnesses. CCM requires at least 20 minutes of care coordination and delivery outside of regular office visits that aim to help patients achieve a better quality of life through the management of their conditions. Because patients with chronic diseases are often limited in their everyday lives and put at risk for functional decline, they require the continuous medical attention provided through CCM.


Typically, CCM services are aimed toward those with two or more chronic conditions prevailing for a year or longer. Some chronic conditions that fall within CCM guidelines include:


  • Alzheimer’s
  • Cancer
  • Diabetes
  • Arthritis
  • Cardiovascular disease
  • Hypertension
  • Stroke
  • Depression
  • Chronic obstructive pulmonary disease (COPD)

Chronic care management is a comprehensive care initiative that considers chronic conditions and any external factors that may affect health. During these services, CCM care providers assess all possible patient challenges such as transportation, language barriers and cognitive impairments to develop a thorough care plan. These providers work to improve access to care, adherence to treatment plans and care team communication. 


With chronic care management, care providers serve as liaisons for patients to help them navigate the complex healthcare system.

TimeDoc Health's Flexible Chronic Care Management Software and Services

At TimeDoc Health, we offer a chronic care management platform that supports your existing technologies by seamlessly integrating with your electronic health records system. Our innovative solution provides a streamlined platform that enables provider teams to document time, manage patient profiles, identify high-risk patients and create metric-based reports to deliver the best possible patient care. 


Many healthcare organizations do not have internal staff dedicated to providing the care required for CCM.  We offer flexible services, where we can supplement your care coordination efforts by taking on any or all of the care provided to patients.


Our CCM platform and services support your broad coordination of care, extending beyond disease management. The TimeDoc Health CCM program streamlines holistic care, from medication reconciliation and appointment scheduling to durable medical equipment (DME) assistance. 


The CCM program facilitates information sharing within care teams, supports seamless care transitions and makes it possible to monitor adherence to comprehensive care plans. With this high-level support, care teams can limit the likelihood of hospitalizations, increase patient satisfaction and improve health outcomes.


More than two-thirds of the population aged 65 and over have two or more chronic conditions. External factors like social determinants of health paired with comorbidities complicate chronic care and disease management. CCM needs a broad scope that addresses related conditions and social factors to improve patient health management. TimeDoc Health offers the unique solution your care teams need.

Unique challenges require unique solutions

We help you drive a continuous stream of revenue through our chronic care management software and services by offering you a custom solution to meet the needs of your organization and the goals of your chronic care management program. 

CCM Software
Allows You To:

Drive ROI of your program

Powerful reporting functionality can deliver insights to help to understand the financial impact your chronic care management program delivers so you can sustain profits year over year.

Maintain Medicare program compliance

Monthly encounter summaries, patient consent, and care plans are stored to be easily accessed in our platform with PDFs pushed into your EHR to assist in case of a Medicare audit.

Reduce time spent on CCM billing

Streamline end-of-the-month CCM billing with reports that automatically tabulate charges based on documented activities that post directly to your EHR.

Easily document time

Advanced EHR integration gives you the ability to document directly from the patient chart so your clinical staff can efficiently log time spent with patients. The easy-to-use interface lets you track day-to-day activities without disrupting clinical workflows.

Automate care planning

Use our physician-created care plans or create your own templates to upload into our platform that synchronizes with your EHR to automatically fill patient information to streamline the care planning process.

Increase care staff efficiency

Dashboards give you real-time visibility into your program size, patient population, and care management productivity. With this functionality, your care team can prioritize their patient panel by risk, minutes documented, active problems, and more.

CCM Services

Staff Augmentation

Many healthcare organizations do not have the capacity to provide the virtual care needed for chronic care management. These practices can utilize our team of medically trained care managers as a remote extension of their practice to coordinate care.

Turnkey Marketing

Expand the awareness of your program by proactively reaching out to patients. Our turnkey marketing services use a multi-channel approach to maximize your program's awareness.

Enrollment Services

Enrollment services help you evaluate the best patients fit for your CCM program and work to increase enrollment through phone-based, direct-to-patient contact. These services take care of educating patients, obtaining consent, and mailing out care plans, ensuring Medicare compliance.

TimeDoc Health Advantage

Our hybrid model can minimize your upfront costs by taking on all the care coordination your healthcare organization cannot handle independently. You can scale this service up and down as you desire to achieve the optimal balance between revenue and workload.

Improve Patient
Outcomes With Chronic Care Management

When you implement chronic care management into your medical facility, you can help patients better manage their chronic conditions, improve health outcomes and enhance their overall quality of life. CCM enables patients to more easily keep track of the many elements of their specialized care while receiving ongoing support from a team of medical professionals.


CCM platforms also promote greater care coordination by keeping providers on the same page with improved communication and organization systems, ensuring the highest level of patient care.

an Innovative Chronic Care Model Into Your Healthcare Facility With TimeDoc Health

With TimeDoc Health’s chronic care management services and software, you can make significant process improvements for patients and providers alike. It’s our mission to improve the quality of life for patients everywhere.


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