Chronic Care Management (CCM)

Chronic Care Management (CCM)

We Deliver Value-Based Care Through Our Unique CCM Practice

It’s not easy to transition to value-based care in today’s healthcare environment. With reimbursements transitioning to value-based, providers cannot afford to let patients walk out of the clinic and just hope that they will comply with their care plan.

Providers need a way to monitor patients once they are out of the clinic, to ensure compliance, identify problems before they become problematic, with the ability to intervene early.

Enter Chronic Care Management.

When done correctly, Chronic Care Management extends the reach of your providers by taking all treatments and instructions home with the patient. By remotely engaging patients on an ongoing basis, you  ensure compliance, get patients actively involved in managing their own health, as
well as identify health issues before they become problematic.

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And with an incentive of $43 per patient per month, practices stand to earn as much as $500 per active patient per year in top line revenue.

The key to a successful CCM program is ongoing patient participation. By leading with a 1:1 care manager-to-patient relationship, and designing an individualized communication schedule to best suit each patient, practices will soon see:

  • Patient conditions improve.
  • Reduction in ED visits and unplanned hospitalization.
  • Improvements in care plan and medication adherence.
  • Ongoing patient participation in health management.

But where does an independent practice find the resources to implement such a program – 24/7 nurse on call, spending 20+ minutes of non face-to-face care per patient per month, not to mention the massive documentation requirements, or expensive technology platform requirements?

Finding the right partner makes all of the difference. With Oculus Health’s turnkey CCM solution, The Golden Age of Independent Practice has arrived.

CCM Program Billing Requirements:

There are 49 billing requirements to compliantly bill CPT 99490, that can be filtered into 3 main categories:

20+ minutes of non face-to-face care management
24/7 Nurse on Call
Sharing Care Plan Electronically

If all requirements are met, and proper documentation of all activities conducted, including timing and duration of all activities, are recorded, then a practice can bill CMS approximately $43 per patient per month.

When evaluating the technology and staffing investment necessary to conduct CCM in a compliant manner, independent practices across the nation have either decided:

  1. Not to implement a CCM program,
  2. Have attempted to conduct internally with little to no success, or
  3. Contracted with one of the many CCM Vendors touting a turnkey solution

In most all cases, practices in category 1 are in the best position. Internal programs have proven themselves unprofitable time and time again. CCM Vendors have failed to maintain patient participation, so at the end of the day, all efforts were for nothing.

One of the greatest challenges is that there hasn’t been a success template or evaluation protocol available to providers and administrators.

Based off of success with tens of thousands of patients that continue to participate in CCM month after month, Oculus has developed an evaluation strategy.

How to Evaluate a Chronic Care Management Solution


Oculus as Your CCM Partner

Oculus isn’t a Vendor. Oculus is a Partner. The ultimate objective of our team is to enable Providers to do what they do best – provide patient care. Part of that is a quick, seamless, and stress free implementation.

Practice Value = Provider Value = Patient Value = Oculus Value

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Getting Started

  1. Oculus seamlessly integrates into practice and provider workflow – this results in the smoothest and most consistent patient experience both in and outside of the clinic.
  2. Little to No Workflow Changes
    1. Oculus is a partner, not a vendor. We identify workflow touch points and integrate accordingly
      1. Getting Started with Oculus Health page (in the works)
    2. Oculus quick and pain free EMR integration ensures no manual upload, no gaps in PHI, and informed and timely interventions

Oculus partners are consistently up and running seamlessly within one week of signing an agreement. Quality measures are tracked automatically from Day 1. Revenue is realized in as little as one month, and only increases day after day.

Oculus’ solutions are designed to align the best interest of all parties involved.



Weekly Care Plan Engagement


Quality Measures Improvement


Increase in Frequency of Communication 

Let’s Get Started
Show me the Money
I have a few Questions
Look at my current practice’s CCM Program