How to Choose a Care Management Partner: 9 Questions

What should we ask before choosing a care-management partner?

Ask who directs clinical care and who bills, which programs the partner supports, who contacts patients and in whose name, where the work is documented, how concerns reach your clinicians, what you will see each month, how long it takes to start, and how privacy is handled.

In-house or with a partner?

A care-management program needs people to reach patients, carry the next steps, and document the work every month. Some organizations hire and supervise that team themselves. Others keep clinical direction and billing in-house and bring in a partner for the outreach and coordination. The requirements of each Medicare service are the same either way, and the billing practitioner remains responsible for them.

Nine questions to ask

1. Who directs clinical care, and who bills?

Clinical decisions, oversight, and the required clinical services should stay with your clinicians, and your organization should bill the eligible services. A partner carries the agreed outreach, coordination, documentation, and follow-through.

2. Which programs can the partner support?

Ask for the full list by name: CCM, TCM, PCM, APCM, RPM, RTM, BHI, CHI, and PIN. Then ask what happens to patients who need help but fit none of them.

3. Who contacts our patients, and how are they introduced?

Agree how patients first hear about the service, whose name is on the outreach, and how consent is recorded before any work starts.

4. Where is the work documented?

Work documented inside your own EMR is visible to your clinicians and supports your claims. Ask whether the partner works in your record or expects you to adopt a separate platform.

5. How do clinical concerns reach our clinicians?

Ask for the escalation path in writing: what a navigator does with a new symptom or a missed medication, who receives it, how fast, and where the outcome is recorded.

6. What will we see each month?

Ask for a sample report. It should separate completed work from attempted work and show open items, not only totals.

7. How long does it take to start, and what do you need from us?

Ask for the timeline from signed agreement to first enrolled patients, and the access, introductions, and clinical owners your team must provide.

8. How are privacy and security handled?

Confirm a business associate agreement, how record access is granted and removed, and who to contact about an incident.

9. Who else has done this with you?

Ask for a named partner you can read about or speak with, and treat outcome numbers without a stated population, period, and source with caution.

How MySeema answers

Your clinicians oversee care and your organization bills eligible services. How this works for physician practices.
We support CCM, TCM, PCM, APCM, RPM, RTM, BHI, CHI, PIN, and medication coordination. See each program.
We document the agreed work in your practice’s EMR. How this works for health systems, ACOs, and networks.
IntraCare, an ACO, chose MySeema for care management. Read about the partnership.
Privacy, security, and responsibilities with partners are described on our Trust & Security page, and more answers are in the FAQ.

How to choose a care-management partner