Primary Care Case Management

Description

In this arrangement, a set of case management services, including coordination and monitoring of primary care services, is delivered to patients at high risk for poor health outcomes or hospitalizations because of chronic conditions or complex social determinants of health. These services are coordinated through—or in cooperation with—the primary care provider. The Primary Care Medical Provider (PCMP) is typically a physical, a physician group practice, or an agency that has an arrangement with the primary care practice to provide case management services. 

Some enhanced PCCM models provide specific disease management services. They may be paid enhanced case management fees for providing the disease management (in addition to their regular case management fees).

Patient Population

Patients with complex or chronic conditions, or who are high-risk for hospitalization

Typical Lead

Primary Care Providers or practices

Role of Home Health Home health providers may participate in PCMPs by contracting with a PCMP to provide case management and/or for disease management services provided in the home
Reimbursement Model PMPM fee for providing care management. Additional fees provided for disease management. These fees are paid in addition to any reimbursement for providing medical services.