If you’re a nurse thinking about starting a business in care management, one of the first questions is: Who am I actually partnering with? There is more than one way to build a nurse-led care management business. Here are three models to consider: 1. Independent Medical Practices Primary care, internal medicine, cardiology, geriatrics, and other independent practices often care for patients with multiple chronic conditions. A nurse care manager can help build and support structured care management services such as chronic care management, remote patient monitoring, transitions of care, patient education, follow-up, and care coordination. The opportunity is not simply “doing CCM.” It is helping the practice create the workflow, identify eligible patients, develop care plans, monitor patients between visits, communicate changes back to the provider, and keep the program organized. 2. Accountable Care Organizations An Accountable Care Organization, or ACO, is a group of healthcare providers working together to improve quality, coordinate care, and manage the total cost of care for a population of patients. That creates opportunities for nurses who understand population health. Think high-risk patient outreach, care transitions, chronic disease management, closing care gaps, reducing avoidable hospitalizations, patient engagement, and supporting practices that may not have enough internal care management staff. Your client may be the ACO itself, or you may partner with practices participating in the ACO. 3. Physicians Serving Long-Term Care and Assisted Living This is another area nurses should be paying attention to. Physicians and advanced practice providers caring for residents in nursing homes and assisted living communities are responsible for medically complex populations, but they are not physically present every day. A nurse care manager can become an additional clinical layer between provider visits. That may include reviewing clinical trends, following hospitalizations and falls, monitoring chronic conditions, coordinating with facility nurses, communicating with families, reviewing changes in the resident’s condition, and helping the provider maintain continuity across the resident’s care.

This one is for the Nurse practitioners in the group and those who want to partner with them. As your practice grows, the question isn’t always, “Can I afford to hire a nurse?” Sometimes the better question is, “Can I continue growing without the clinical infrastructure my patients need?” In this case study, we follow an independent family nurse practitioner in Suffolk County, New York, with a growing panel of more than 500 patients. She’s seeing patients, managing chronic conditions, answering messages, handling refills and referrals, reviewing labs, coordinating care, documenting, and trying to keep the practice moving at the same time. Sound familiar? This resource walks you through how Chronic Care Management (CCM) could be used as part of a structured approach to supporting patients between office visits while building additional clinical capacity within the practice. Using a simplified example of 100 eligible and enrolled Medicare patients and CPT 99490, we’ll break down: - How CCM can support a growing chronic-care population - Why the Medicare Physician Fee Schedule matters - How to find and understand your locality-specific reimbursement - What 100 CCM patients could potentially generate in gross allowed revenue - How much qualifying clinical staff time that patient panel represents - Why you may not need a full-time RN to begin building nursing support - The difference between revenue and profit - How to think about nursing as clinical infrastructure rather than simply another expense The goal of this lesson is not to convince you to implement CCM just because there is a CPT code. The goal is to teach you how to look at your patient population, identify gaps in care, understand the work happening between visits, and determine whether a sustainable care-management model could help you provide better support while creating room for your practice to grow. Educational resource only. Reimbursement, eligibility, documentation, coding, compliance, and payer requirements should always be verified for your individual practice before implementation.

I can’t believe we’re at 162 members. 😍 First, thank you to every nurse who has joined this community and continues to show up here. I know I haven’t been as active lately. Life has been life-ing over here. Recently, I lost the per diem nursing job that was helping me fund my business. And while I definitely didn’t plan for that, it pushed me back into a place I honestly thought I had left behind: long-term care. I spent more than 15 years working in long-term care in different nursing roles. But this time, I’m returning with a completely different lens. I’m returning as a nurse who understands care management, value-based care, chronic care management, remote patient monitoring, and the business side of healthcare. And I’m seeing opportunities I didn’t see before. My care management journey started with partnering with primary care practices in the community. Now, I’m exploring how nurses can work with physicians and other providers caring for patients inside long-term care facilities. Not necessarily working for the facility. Working with the provider to help manage their patients between visits. That has opened up an entirely new direction for my business, and I’m going to share that journey here as I build it. Sometimes that may be a video. Sometimes a PDF, resource, lesson, or simply a post sharing what I’m learning and implementing in real time. And whether you’re an LPN or RN, I want you to understand that the business of care management is much bigger than one service, one setting, or one business model. There are so many ways nurses can use the experience we already have to improve care and create opportunities beyond the traditional bedside role. So, 162 members later, we’re still here. And apparently, I still have a lot more to share. Thank you for being here. ❤️