What Conditions Qualify for Chronic Care Management?

Story by Connor Danielowski / March 21, 2025

Chronic Care Management (CCM) is a vital Medicare program designed to support patients in managing their chronic conditions more effectively. Through CCM, patients receive dedicated care coordination, ensuring they stay on top of their health goals, medications, and necessary appointments. However, many healthcare providers may not fully understand which conditions qualify a patient for CCM.

To help you determine whether your practice serves patients eligible for Chronic Care Management, we’ve outlined a comprehensive list of qualifying conditions and how CCM can significantly enhance patient care and outcomes.

Who Qualifies for Chronic Care Management?

Medicare requires patients to have at least two or more chronic conditions that are expected to last 12 months or longer and put them at risk of health deterioration or functional decline. The decision to enroll a patient in CCM ultimately depends on the provider’s clinical judgment.

Below is a breakdown of the common chronic conditions that typically qualify for CCM:

Cardiovascular & Blood Disorders

• Hypertension (High Blood Pressure)
• Coronary Artery Disease (CAD)
• Congestive Heart Failure (CHF)
• Atrial Fibrillation (AFib)
• Hyperlipidemia (High Cholesterol)
• Peripheral Vascular Disease (PVD)
• Sickle Cell Disease
• Ischemic Heart Disease

Chronic Respiratory Conditions

• Chronic Obstructive Pulmonary Disease (COPD)
• Asthma
• Emphysema
• Cystic Fibrosis

Metabolic & Endocrine Disorders

• Diabetes (Type 1 and Type 2)
• Hypothyroidism
• Obesity
• Metabolic Syndrome

Neurological & Mental Health Conditions

• Alzheimer’s Disease & Other Dementias
• Parkinson’s Disease
• Epilepsy & Seizure Disorders
• Stroke
• Traumatic Brain Injury (TBI)
• Bipolar Disorder
• Anxiety & Depressive Disorders
• Schizophrenia & Other Psychotic Disorders
• Post-Traumatic Stress Disorder (PTSD)

Musculoskeletal & Autoimmune Conditions

• Osteoporosis
• Rheumatoid Arthritis
• Osteoarthritis
• Multiple Sclerosis (MS)
• Fibromyalgia
• Chronic Pain Syndrome
• Spinal Cord Injuries

Gastrointestinal & Digestive Disorders

• Crohn’s Disease
• Ulcerative Colitis
• Irritable Bowel Syndrome (IBS)
• Liver Disease & Cirrhosis

Kidney & Urological Conditions

• Chronic Kidney Disease (CKD)
• Benign Prostatic Hyperplasia (BPH)
• Kidney Cysts

Eye & Vision Disorders

• Glaucoma
• Diabetic Retinopathy
• Age-Related Macular Degeneration (AMD)
• Cataracts

Hearing & ENT Conditions

• Tinnitus
• Vertigo
• Hearing Loss
• Meniere’s Disease

Substance Use Disorders

• Alcohol Use Disorder
• Opioid Use Disorder
• Nicotine Dependence
• Other Drug Use Disorders

Other Disabling & Chronic Conditions

• Human Immunodeficiency Virus (HIV) & Acquired Immunodeficiency Syndrome (AIDS)
• Viral Hepatitis
• Developmental & Intellectual Disabilities
• Blindness & Severe Visual Impairments

How Chronic Care Management Supports Patients

Once a patient qualifies for CCM, they gain access to essential care coordination services, including:

• Monthly check-ins from a care coordinator
• Medication management and prescription refills
• Help scheduling appointments and follow-ups
• Creation of a personalized care plan to track health goals and needs
• Assistance with community resources such as transportation, food, and housing support

These services are designed to reduce hospitalizations, improve medication adherence, and enhance overall patient quality of life. By integrating CCM into your practice, you can provide ongoing, proactive care that prevents complications and supports better health outcomes.

Why Choose Chronic Care Staffing for CCM Services?

At Chronic Care Staffing, we specialize in providing seamless CCM program implementation for healthcare practices. Our CCM program requires no software integration, zero upfront costs, and all documentation is charted in real-time directly in your EMR. Our team helps identify eligible patients, handles enrollment, and delivers high-quality care coordination—allowing your practice to focus on in-person patient care while ensuring your CCM patients receive continuous support.

If your practice is looking to enhance patient care and improve health outcomes through Chronic Care Management, reach out to us today. Let’s work together to provide the best care possible for patients managing chronic conditions.

Contact Chronic Care Staffing today to learn more about CCM and how we can help your practice.

Connor Danielowski

Chief Operating Officer, Chronic Care Staffing

Connor Danielowski is the Chief Operating Officer at Chronic Care Staffing, where he leads operations, strategy, and growth initiatives focused on delivering high-impact virtual care solutions. He brings a unique blend of clinical service knowledge and financial expertise to help healthcare organizations implement and scale Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and other virtual care management services.

Connor began his career in investment banking and private equity, where he focused on investing in healthcare businesses and working closely with management teams to drive revenue growth and profitability. This experience shaped his hands-on, results-oriented approach to healthcare operations today.

He holds a degree in Accounting from Washington & Lee University and brings both analytical rigor and a patient-first mindset to his role. In addition to his work at Chronic Care Staffing, Connor serves on the development board for the MUSC College of Nursing. He lives in Charleston, SC, with his wife and son.

Categories: Chronic Care Management News

Tags: CCM, CCM Services, Chronic Care Management, Chronic Care Staffing