Care Management

Sources and review notes

These links support definition-level research and do not establish the regulatory status, safety, or suitability of any product.

AHRQ describes care coordination as the deliberate organization of patient-care activities and information exchange among participants, including the patient, while noting that no single consensus definition covers every use. CMS's chronic care management guidance describes patient-centered care plans, goals, monitoring, medical and psychosocial needs, caregivers, outside resources, specialty coordination, and periodic review for eligible Medicare services. CMS's advanced primary care management guidance adds continuity, urgent access, transitions, preventive-service follow-up, and ongoing communication across clinical and community providers. These CMS requirements are program- and billing-specific and do not define all care management, validate an AI system, determine clinical eligibility or priority, or prove engagement, utilization, outcome, equity, or cost improvement. Organizations must define accountable clinicians and care-team roles, population and payer rules, patient goals and consent, source-data completeness and timeliness, identity and care-plan provenance, medication and transition reconciliation, communication accessibility, risk-model validation and fairness, urgent and clinical escalation, closed-loop task ownership, staff override, outcome measurement, and auditable documentation.

• Source 1: www.ahrq.gov/ncepcr/care/coordination/atlas/chapter2.html
• Source 2: www.cms.gov/medicare/payment/fee-schedules/physician-fee-schedule/chronic-care-management-complex-conditions
• Source 3: www.cms.gov/medicare/payment/fee-schedules/physician-fee-schedule/advanced-primary-care-management-services