Care Management Programs
HealthSpan delivers a full spectrum of CMS-aligned care management programs, operated end to end across staffing, technology, and compliance. Programs are configured to match your clinical and organizational needs while reducing operational burden and improving care continuity between visits.
Program Portfolio
HealthSpan supports a broad spectrum of CMS-aligned care management programs. Below are the core program categories we operate today, with RPM, CCM, and BHI highlighted as representative examples.
Remote Patient Monitoring (RPM)
Continuous device-based monitoring with clinical oversight between visits.
Chronic Care Management (CCM)
Monthly care coordination and outreach for complex chronic populations.
Behavioral Health Integration (BHI)
Integrated behavioral screening, care coordination, and reporting.
Principal Care Management (PCM)
High-touch management for patients with a single serious condition.
Remote Therapeutic Monitoring (RTM)
Device and app-based therapy adherence monitoring with clinician review.
Transitional Care Management (TCM)
Post-discharge follow-up and coordination to reduce readmissions.
Remote Patient Monitoring (RPM)
HealthSpan operates RPM programs end-to-end, managing device logistics, patient orientation, data ingestion and clinical escalation workflows. Our team ensures consistent patient engagement, timely interventions, and billing-ready documentation so providers can scale RPM without adding operational burden while maintaining continuity of care between visits.
Devices & Measurements
HealthSpan supports continuous monitoring across blood pressure, glucose (CGM), weight, pulse oximetry, and other condition-specific devices. Programs are configured with population-specific measurement schedules, alert thresholds, and escalation rules aligned to clinical protocols. Device provisioning, replacements, and logistics are centrally managed to eliminate operational overhead for healthcare providers.
Interaction & Intent
Patient engagement is structured around proactive outreach, education, and adherence support rather than passive data collection. Clinical teams review readings, trigger interventions when thresholds are breached, and conduct monthly touchpoints to satisfy RPM engagement requirements. Workflows are designed to ensure documentation, responsiveness, and continuity of care without overwhelming provider staff.
Outcomes & Value
RPM enables earlier identification of clinical deterioration, tighter control of chronic conditions, and more timely interventions between visits. Patients benefit from an increased sense of support, continuity, and accountability, while providers gain clearer visibility into real-world patient status. Programs are designed to improve stability, reduce preventable complications, and strengthen long-term care outcomes across complex populations.
Program Operations
HealthSpan operates the day-to-day RPM pataient program experience. This includes patient onboarding & orientation, medication adherence, data intake and triage, clinical review workflows, escalation handling, and longitudinal documentation. Providers retain clinical oversight and decision-making authority while HealthSpan supplies the staffing, systems, and operational structure required to sustain consistent care between visits.
Chronic Care Management (CCM)
HealthSpan supports longitudinal condition monitoring across hypertension, diabetes, heart failure, COPD, and other chronic conditions. Programs are configured with population-specific data inputs, care plan structures, and documentation workflows aligned to clinical protocols. Where applicable, device-based data such as blood pressure, glucose, or weight is integrated into the CCM record to support a unified patient view across RPM and CCM programs.
Devices & Measurements
HealthSpan supports longitudinal condition monitoring across hypertension, diabetes, heart failure, COPD, and other chronic conditions. Programs are configured with population-specific data inputs, care plan structures, and documentation workflows aligned to clinical protocols. Where applicable, device-based data such as blood pressure, glucose, or weight is integrated into the CCM record to support a unified patient view across RPM and CCM programs.
Interaction & Intent
CCM engagement is structured around scheduled outreach, medication reconciliation, care plan reviews, and patient education rather than reactive follow-ups alone. Care teams conduct monthly touchpoints, address care gaps, and coordinate services based on evolving patient needs. Workflows are designed to ensure continuity of care, timely interventions, and consistent documentation without overwhelming provider staff.
Outcomes & Value
CCM enables earlier identification of clinical drift, improved medication adherence, and tighter management of complex chronic conditions over time. Patients benefit from increased support, stability, and accountability between visits, while providers gain clearer visibility into care plan execution and patient progress. Programs are designed to reduce preventable complications, improve quality of life, and strengthen long-term care outcomes across high-risk populations.
Program Operations
HealthSpan operates the day-to-day CCM program experience from the patient outward. This includes care plan configuration, monthly outreach workflows, medication reconciliation support, data intake and triage, clinical review workflows, escalation handling, and longitudinal documentation. Providers retain clinical oversight and decision-making authority while HealthSpan supplies the staffing, systems, and operational structure required to sustain consistent chronic care management between visits.
Behavioral Health Integration (BHI)
HealthSpan delivers structured behavioral health integration programs designed to identify, support, and manage patients with depression, anxiety, cognitive decline, and related conditions. Programs combine standardized screening, proactive outreach, and coordinated care workflows to extend behavioral health support beyond episodic office visits. HealthSpan manages patient engagement, documentation, and care coordination so providers can deliver integrated behavioral care without adding operational burden.
Screening & Assessments
HealthSpan supports structured behavioral health screening across depression, anxiety, cognitive decline, and related conditions using validated instruments. Programs are configured with population-specific assessment schedules, documentation workflows, and care pathways aligned to clinical protocols. Screening data is integrated into the patient record to support coordinated medical and behavioral care planning.
Interaction & Intent
BHI engagement is structured around proactive outreach, care coordination, patient education, and follow-up rather than episodic referrals alone. Care teams conduct scheduled check-ins, reinforce treatment plans, and coordinate services based on behavioral health needs. Workflows are designed to ensure responsiveness, continuity of care, and documentation integrity without disrupting provider clinical flow.
Oucomes & Value
BHI enables earlier identification of behavioral health concerns, improved adherence to treatment plans, and stronger coordination between medical and behavioral care. Patients benefit from increased emotional support, continuity, and access to resources between visits, while providers gain clearer visibility into behavioral health trends and care engagement. Programs are designed to improve stability, reduce crisis events, and strengthen long-term outcomes across complex populations.
Program Operations
HealthSpan operates the day-to-day CCM program experience from the patient outward. This includes care plan configuration, monthly outreach workflows, medication reconciliation support, data intake and triage, clinical review workflows, escalation handling, and longitudinal documentation. Providers retain clinical oversight and decision-making authority while HealthSpan supplies the staffing, systems, and operational structure required to sustain consistent chronic care management between visits.
Additional Programs Supported
HealthSpan also supports condition-specific and episodic care management programs that operate on the same clinical, operational, and documentation infrastructure as our core RPM, CCM, and BHI offerings. These programs are typically layered into an existing engagement based on patient population needs, care complexity, and practice goals, enabling providers to expand services without introducing new workflows or operational burden.
Principal Care Management (PCM)
Principal Care Management provides focused, high-touch support for patients managing a single serious or complex condition such as heart failure, COPD, or advanced diabetes. Programs are structured around condition-specific care plans, frequent outreach, medication support, and clinical coordination. HealthSpan operates the underlying workflows, patient engagement, and documentation required to sustain consistent care for high-acuity populations while preserving provider oversight and clinical decision-making authority.
Remote Therapeutic Monitoring (RTM)
Remote Therapeutic Monitoring supports therapy adherence and engagement across musculoskeletal, respiratory, and digital therapeutic programs. Programs combine patient-reported outcomes, therapy compliance tracking, and structured follow-up workflows to extend care beyond in-office treatment sessions. HealthSpan manages patient engagement, data intake, and documentation processes so providers can deliver longitudinal therapy support without adding operational complexity.
Transitional Care Management (TCM)
Transitional Care Management provides short-term post-discharge support to ensure safe transitions from inpatient to outpatient care. Programs are structured around timely outreach, medication reconciliation, care coordination, and follow-up scheduling during the critical post-discharge window. HealthSpan operates the patient engagement, coordination workflows, and documentation required to reduce readmission risk while maintaining continuity of care during recovery.