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Connected Care: New CMS Educational Initiative on Chronic Care Management

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The Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) and the Federal Office of Rural Health Policy at the Health Resources and Service Administration (HRSA) have introduced Connected Care, a new educational initiative to raise awareness of the benefits of chronic care management (CCM) services for Medicare beneficiaries with multiple chronic conditions and to support health care professionals in implementing CCM programs. Connected Care is a nationwide effort within fee-for-service Medicare that includes a focus on racial and ethnic minorities as well as rural populations, who tend to have higher rates of chronic disease. 

Two-thirds of Medicare beneficiaries have two or more chronic conditions, and one-third have four or more chronic conditions. By offering CCM services, health care professionals can deliver the coordinated care their patients need and deserve and help patients stay on track by getting support between visits. Many health care professionals already provide CCM services, including non-face-to-face services such as reviewing test results or coordinating with other providers. However, many providers are not aware of the separate CCM payments under the Medicare Physician Fee Schedule and many are not receiving the full separate payments for CCM services now available under Medicare Part B

“This important initiative builds on our efforts to help providers care for patients with multiple chronic conditions," said Cara James, PhD, Director of the Centers for Medicare & Medicaid Services Office of Minority Health. "We are excited to be working with the Health Resources and Services Administration to reach vulnerable populations."

To support the Connected Care initiative, CMS and HRSA developed new resources to help educate patients and provide information for health care professionals, including 

  • a toolkit for health care professionals, with detailed information about CCM and resources to help providers implement it
  • a partner toolkit that includes downloadable resources and suggested activities to get involved in the Connected Care initiative
  • patient education resources, including a poster and postcard that can be used in a clinical or community setting. 

All resources are available online at go.cms.gov/ccm and can be ordered at no cost. 

For more information on how to get involved with the CCM initiative and learn more about chronic care management, visit go.cms.gov/ccm                      

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