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How to Start a Chronic Care Management Business

A chronic care management business provides ongoing support and coordination for patients with chronic conditions to improve their health outcomes and quality of life.

These businesses employ healthcare professionals such as nurses, care coordinators, and health coaches who work closely with patients to develop personalized care plans, monitor their health status, and facilitate communication between patients and their healthcare providers.

According to a report by Grand View Research, the global chronic care management market size was valued at $9.2 billion in 2020 and is projected to reach $24.9 billion by 2027, with a compound annual growth rate (CAGR) of 14.3%.

This growth is driven by factors such as the rising prevalence of chronic diseases, increasing demand for remote patient monitoring, and efforts to reduce healthcare costs through preventative care.

Steps on How to Start a Chronic Care Management Business

  1. Conduct Market Research

Conducting market research for a chronic care management business involves several key steps to ensure a thorough understanding of the market landscape and customer needs.

Firstly, it’s essential to define the target market by identifying demographics such as age, gender, location, and socioeconomic status, as well as specific chronic conditions prevalent within these demographics. Utilizing data from sources like census reports, health surveys, and medical literature can help in this process.

Secondly, analyze the competitive landscape by identifying existing chronic care management providers, their service offerings, pricing models, and market share.

This involves gathering information through online research, industry reports, and direct observation of competitors’ marketing strategies.

Thirdly, gather insights into customer preferences and pain points through surveys, focus groups, and interviews with patients, caregivers, healthcare providers, and payers.

Understanding the challenges they face in managing chronic conditions, their preferences for care delivery, and the factors influencing their decision-making process can inform the development of tailored chronic care management services.

Lastly, assess market trends and regulatory factors impacting the chronic care management industry, such as changes in healthcare policies, reimbursement models, technological advancements, and shifts in consumer behavior.

Staying updated on these trends can help anticipate future opportunities and challenges, allowing the CCM business to adapt its strategies accordingly and maintain a competitive edge in the market.

a. Who is the Target Market for Chronic Care Management Business?
  • Patients with chronic conditions (e.g., diabetes, hypertension, heart disease)
  • Elderly individuals requiring ongoing care and monitoring
  • Caregivers responsible for managing the health of loved ones
  • Healthcare providers seeking support in managing patients with chronic illnesses
  • Payers such as insurance companies and government healthcare programs interested in cost-effective disease management solutions.
b. Is Chronic Care Management Business a Profitable Business?

Yes, chronic care management businesses can be profitable due to increasing demand for services. The global chronic care management market was valued at $9.2 billion in 2020, with a projected growth to $24.9 billion by 2027, indicating substantial revenue potential.

Factors such as rising prevalence of chronic diseases, demand for remote patient monitoring, and cost-saving initiatives through preventative care contribute to its profitability.

Additionally, reimbursement opportunities from healthcare payers further bolster the financial viability of chronic care management businesses.

c. Are There Existing Niches in the Industry?

No, there are no existing niche ideas when it comes to chronic care management business.

d. Who are the Major Competitors?
  • Chronic Care Management, Inc.
  • CareSync
  • CareBridge International
  • eQHealth Solutions
  • Livongo Health
  • Care Innovations
  • Vivify Health
  • ChronicCareIQ
  • Care Team Solutions
  • CareCentrix
  • iHealthHome
  • Persivia
  • CareVitality
  • Health Recovery Solutions
  • Signallamp Health
  • ChronicCare Plus
  • CareAllies
  • Prevounce Health
  • CareHarmony
  • Remote Patient Monitoring Services.
e. Are There County or State Regulations or Zoning Laws for Chronic Care Management Business in the United States?

In the United States, regulations and zoning laws for chronic care management businesses vary by county and state. These regulations often stem from broader healthcare laws and licensing requirements.

Many states have specific regulations governing healthcare facilities, which can include chronic care management businesses. These regulations may cover aspects such as facility standards, staffing requirements, and patient safety protocols.

Additionally, chronic care management businesses must adhere to federal regulations such as HIPAA (Health Insurance Portability and Accountability Act), which protect patient privacy and security.

Zoning laws also play a role in determining where chronic care management businesses can operate. Zoning ordinances regulate land use and dictate which types of businesses can operate in specific areas.

Chronic care management businesses may need to obtain special permits or meet certain zoning criteria to operate in particular locations.

Furthermore, reimbursement policies and regulations from government healthcare programs like Medicare can impact chronic care management businesses.

These programs often have specific criteria that providers must meet to qualify for reimbursement for chronic care management services.

f. Is There a Franchise for Chronic Care Management Business?

No, there are no franchise opportunities for chronic care management businesses.

g. What Do You Need to Start a Chronic Care Management Business?
  • Business plan
  • Legal structure (e.g., LLC, corporation)
  • Healthcare professionals (e.g., nurses, care coordinators)
  • Office space or facility
  • Equipment and technology (e.g., computers, medical devices)
  • Electronic health record (EHR) system
  • Policies and procedures
  • Marketing and branding materials
  • Insurance (e.g., liability insurance)
  • Compliance with healthcare regulations
  • Partnerships with healthcare providers
  • Billing and reimbursement infrastructure.
  1. Choose a Memorable Business Name

When looking to start a business, before you can begin to file the necessary documents with the constituted authorities or start your website, it is necessary that you come up with a name that you will be recognized with.

It is essential that the name you come up with can easily be pronounced, is unique and easily memorable. Some of the catchy business name ideas suitable for a chronic care management business are;

Creative Chronic Care Management Business Name ideas
  • Queenly Harry® Chronic Care Management, Inc.
  • Life Gate® Chronic Care Management, LLC
  • Green Cross™ Chronic Care Management, Inc.
  • Anthonia Spencer™ Chronic Care Management Inc.
  • Jude Davidson® Chronic Care Management, LLC
  • Blue Cross® Chronic Care Management, Inc.
  • Refresh Base® Chronic Care Management, Inc.
  • Stay Alive® Chronic Care Management, Inc.
  • Rachael Kingston® Chronic Care Management, Inc.
  • Sharon Emerson® Chronic Care Management, LLC
  • Peniel Dickson® Chronic Care Management, LLC
  • Glory George® Chronic Care Management, LLC
  • Praise Nelson® Chronic Care Management, Inc.
  • Joyce Joseph® Chronic Care Management, Inc.
  • Jude® Chronic Care Management, Inc.
  • Laura Winston® Chronic Care Management, Inc.
  • Jacinta McClurkin® Chronic Care Management, Inc.
  • Romanus Linus® Chronic Care Management, LLC
  • Reginald Wright® Chronic Care Management, LLC
  • Julie Morgan® Chronic Care Management, Inc.
  1. Register Your Business

a. What Type of Business Structure is Best for Chronic Care Management Business?

The best type of business structure for a chronic care management business depends on several factors, including the size of the business, the number of owners, and the level of personal liability exposure the owners are willing to accept.

However, we usually recommend a Limited Liability Company (LLC) for chronic care management business. An LLC is a popular choice for small businesses because it offers personal liability protection for the owners while allowing them to be taxed as a pass-through entity.

This means that the profits and losses of the business are passed through to the owners’ tax returns, avoiding double taxation.

b. Steps to Form an LLC
  • Choose a Name for Your LLC.
  • File Articles of Organization.
  • Choose a registered agent.
  • Decide on member vs. manager management.
  • Create an LLC operating agreement.
  • Comply with other tax and regulatory requirements.
  • File annual reports.
c. What Type of License is Needed to Open a Chronic Care Management Business?
  • Business License
  • Healthcare Facility License
  • Professional License for Healthcare Providers (e.g., nursing license)
  • Medicare Provider Enrollment
  • Medicaid Provider Enrollment
  • National Provider Identifier (NPI) Number
  • Controlled Substance Registration (if applicable)
  • Health Information Privacy Compliance (e.g., HIPAA)
  • Occupational Safety and Health Administration (OSHA) Compliance
  • Accreditation from relevant healthcare accreditation bodies.
d. What Type of Certification is Needed to Open a Chronic Care Management Business?
  • Certified Medical Manager (CMM)
  • Certified Professional in Healthcare Quality (CPHQ)
  • Certified Case Manager (CCM)
  • Certified Chronic Care Professional (CCCP)
  • Certified Healthcare Access Manager (CHAM).
e. What Documents are Needed to Open a Chronic Care Management Business?
  • Business Plan
  • Articles of Incorporation or Organization
  • Operating Agreement (for LLCs)
  • Business License
  • Healthcare Facility License
  • Professional Licenses for Healthcare Providers
  • Tax Identification Number (TIN)
  • Medicare Provider Enrollment Application
  • Medicaid Provider Enrollment Application
  • National Provider Identifier (NPI) Number
  • Certificate of Insurance (e.g., liability insurance)
  • Policies and Procedures Manual
  • HIPAA Compliance Documentation
  • Employment Agreements or Contracts
  • Billing and Reimbursement Procedures.
f. Do You Need a Trademark, Copyright, or Patent?

A chronic care management business may require a trademark, copyright, or patent depending on the specific circumstances. A trademark is used to protect logos, brand names, slogans, or any distinctive signs that distinguish your chronic care management business from others in the marketplace.

Copyright protection is relevant if you have original creative works, such as written materials, marketing content, website designs, or artistic elements associated with your chronic care management business.

Copyright automatically applies to original works as soon as they are created, granting the creator exclusive rights to reproduce, distribute, display, or perform the work.

While patents can be obtained for new medical devices or unique equipment used in the chronic care management process, they are less commonly applicable to the general operation of a chronic care management business.

Patents grant exclusive rights to the inventor, preventing others from making, using, selling, or importing the patented invention.

  1. Cost Analysis and Budgeting

a. How Much Does It Cost to Start a Chronic Care Management Business?

When it comes to starting a chronic care management business, the startup costs vary, and it could range from as low as $350,000 to over $700,000.

b. What are the Costs Involved in Starting a Chronic Care Management Business?
  • Business Registration Fees – $750.
  • Legal expenses for obtaining licenses and permits – $7,300.
  • Marketing, Branding, and Promotions – $5,000.
  • Business Consultant Fee – $2,500.
  • Insurance – $5,400.
  • Rent/Lease – $100,000.
  • Operational Cost (salaries of employees, payments of bills et al) – $200,000
  • start-up inventory (medical supplies) – $25,000
  • Store Equipment (cash register, security, ventilation, signage) – $4,750
  • Furnishing and Equipping – $350,000
  • Website: $600
  • Opening party: $3,000
  • Miscellaneous: $2,000.
c. What Factors Determine the Cost of Opening a Chronic Care Management Business?
  • The size of the chronic care management business
  • The choice of location
  • The required licenses and permits
  • The cost of hiring and paying a business consultant and attorney
  • The cost of branding, promotion, and marketing of the chronic care management business
  • The cost of furnishing and equipping the chronic care management facility
  • The cost of the insurance policy covers
  • The cost of registering the business
  • Cost of recruiting and training your staff
  • The cost for the purchase and customizing of uniforms, shoes, and caps for your employees
  • The cost for the grand opening of the Chronic care management business.
d. Do You Need to Build a Facility? If YES, How Much Will It Cost?

Whether or not you need to build a facility for a chronic care management clinic depends on the specific circumstances. In some cases, an existing space, such as a medical office can be used to set up a chronic care management business.

However, in other cases, a new facility may need to be built. The cost of building a new facility can vary widely depending on factors such as location, size, materials, and amenities.

According to some estimates, the cost can range from $100 to $300 per square foot. This means that a 1,000-square-foot Chronic care management clinic could cost anywhere from $100,000 to $300,000 to build.

e. What are the Ongoing Expenses of a Chronic Care Management Business?
  • Staff salaries and benefits
  • Rent or mortgage for office space
  • Utilities (electricity, water, internet)
  • Medical equipment and supplies
  • Electronic health record (EHR) system subscription fees
  • Insurance premiums (liability, malpractice)
  • Marketing and advertising expenses
  • Continuing education and training for staff
  • Billing and coding software fees
  • Telecommunication expenses
  • Professional association memberships
  • Maintenance and repairs for equipment and facilities.
f. What is the Average Salary of your Staff?
  • Chief Medical Director (President) – $125,000 Per Annum
  • Registered Nurse (RN) – $75,000 Per Annum
  • Care Coordinator – $70,000 Per Annum
  • Health Coach – $70,000 Per Annum
  • Medical Assistant – $65,000 Per Annum
  • Administrative Assistant – $50,000 Per Annum
  • Billing Specialist – $50,000 Per Annum
  • Customer Service Officer (Receptionist) – $40,000 Per Annum.
g. How Do You Get Funding to Start a Chronic Care Management Business?
  • Raising money from personal savings and sale of personal stocks and properties
  • Raising money from investors and business partners
  • Sell shares to interested investors
  • Applying for a loan from your bank/banks
  • Pitching your business idea and applying for business grants and seed funding from the government, donor organizations, and angel investors
  • Source for soft loans from your family members and friends.
  1. Write a Business Plan

a. Executive Summary

Nicholas Williams® Chronic Care Management, Inc. is a premier provider of chronic care management services located in Minneapolis, Minnesota.

We are set to enhance the quality of life for individuals with chronic conditions through personalized, comprehensive care management and support.

With the rising prevalence of chronic diseases and an aging population, the demand for chronic care management services is growing. In the United States, 6 in 10 adults have a chronic disease, and 4 in 10 have two or more.

Our location in Minneapolis, a city known for its high quality of healthcare services, positions us well to meet this increasing need.

Our dedicated team includes registered nurses, care coordinators, health coaches, medical assistants, administrative assistants, and billing specialists. Each team member is committed to providing exceptional care and support to our patients.

b. Products and Service

We offer a range of services including care coordination, health coaching, medication management, remote patient monitoring, and patient education.

Our goal is to reduce hospital readmissions, improve patient outcomes, and lower healthcare costs by providing continuous and proactive care.

c. Mission Statement

At Nicholas Williams® Chronic Care Management, Inc., our mission is to improve the quality of life for individuals with chronic conditions through compassionate, comprehensive, and personalized care.

We are dedicated to providing continuous support, education, and innovative care solutions to empower our patients in managing their health and achieving optimal well-being.

Vision Statement:

Our vision is to be the leading provider of chronic care management services in Minnesota, recognized for our commitment to excellence, patient-centered approach, and innovative care models.

We strive to transform the landscape of chronic disease management by fostering healthier communities and setting new standards for quality and accessibility in chronic care.

d. Goals and Objectives

At Nicholas Williams® Chronic Care Management, Inc., our goals and objectives are to enhance patient health outcomes, reduce hospital readmissions, and lower healthcare costs through personalized care plans and continuous monitoring.

We aim to build strong partnerships with healthcare providers and payers, deliver exceptional patient education and support, and utilize innovative technologies for efficient care management.

e. Organizational Structure
  • Chief Medical Director (President)
  • Registered Nurse (RN)
  • Care Coordinator
  • Health Coach
  • Medical Assistant
  • Administrative Assistant
  • Billing Specialist
  • Customer Service Officer (Receptionist).

Marketing Plan

a. SWOT Analysis
  • Our team of experienced healthcare professionals, including registered nurses, care coordinators, and health coaches, provides high-quality, compassionate care.
  • Offering a wide range of services such as care coordination, medication management, and remote patient monitoring ensures we meet diverse patient needs.
  • Based in Minneapolis, a hub for high-quality healthcare, enhances our accessibility to potential clients and reputable healthcare partners.
  • Strong focus on personalized care plans and continuous patient support fosters high patient satisfaction and improved health outcomes.
  • Use of advanced electronic health record (EHR) systems and remote monitoring technologies improves efficiency and care quality.
  • The need for skilled personnel and advanced technologies results in significant operational expenses.
  • Navigating complex healthcare regulations and ensuring compliance can be resource-intensive.
  • As a new entrant, building brand recognition and trust within the community may take time and effort.
  • Dependence on reimbursements from Medicare, Medicaid, and private insurers can pose financial risks due to potential changes in policies.
  • Increasing prevalence of chronic diseases and an aging population drive demand for chronic care management services.
  • Opportunities to form strategic alliances with hospitals, clinics, and insurance providers to expand our service reach.
  • Continued advancements in healthcare technology can enhance service delivery and operational efficiency.
  • The rise of telehealth presents opportunities to offer remote care services, increasing accessibility for patients.
  • Growing emphasis on preventative care and wellness programs aligns with our service model and can attract more clients.
  • The chronic care management industry is competitive, with established players posing a challenge to market entry and growth.
  • Changes in healthcare laws and reimbursement policies can impact operational stability and profitability.
  • Economic challenges can affect patients’ ability to afford care and influence funding availability from insurers.
  • Ensuring the security and privacy of patient data is critical, with breaches potentially damaging reputation and incurring legal consequences.
  • Shortages in qualified healthcare professionals can impact service delivery and quality.
b. How Do Chronic Care Management Businesses Make Money?

Chronic care management businesses make money primarily through reimbursements from Medicare, Medicaid, and private insurance for providing continuous care services to patients with chronic conditions.

They also generate revenue by partnering with healthcare providers and payers to offer care coordination, remote patient monitoring, and patient education.

Additional income streams include service fees for personalized care plans and technology integration, such as electronic health record (EHR) systems and telehealth platforms.

c. Payment Options
  • Credit or Debit Card
  • Cash
  • Electronic Payment Systems such as PayPal or Venmo
  • Checks
  • Bank Transfers.
d. Sales & Advertising Strategies
  • Utilize social media, search engine optimization (SEO), and online advertising to reach potential clients and caregivers.
  • Develop partnerships with local healthcare providers, clinics, and hospitals to gain patient referrals.
  • Host informational seminars, health fairs, and workshops in the community to raise awareness about chronic care management services.
  • Create valuable content such as blog posts, newsletters, and educational videos to establish authority and attract potential clients.
  • Invest in targeted online ads, including Google Ads and social media ads, to reach specific demographics.
  • Showcase positive testimonials and case studies from satisfied patients to build trust and credibility.
  • Send informative brochures and postcards to households in target areas to introduce your services.

Financial Projection

a. How Much Should You Charge for your Product/Service?

Below is an itemized list of typical charges:

Initial Enrollment and Assessment:
  • $50 to $100 (one-time fee)
Monthly Chronic Care Management Services:
  • Non-Complex CCM (20 minutes of clinical staff time per month): $40 to $60 per month
  • Complex CCM (60 minutes or more of clinical staff time per month): $100 to $150 per month
Remote Patient Monitoring (RPM):
  • Initial setup and patient education: $20 to $50 (one-time fee
  • Monthly monitoring and management: $50 to $120 per month
Telehealth Consultations:
  • Per consultation: $30 to $75
Medication Management:
  • Monthly fee: $20 to $50
Health Coaching and Education:
  • Per session: $40 to $80
  • Monthly packages: $100 to $200
Care Coordination and Case Management:
  • Monthly fee: $60 to $120.
b. How Much Profit Do Chronic Care Management Business Owners Make a Year?

Chronic care management business owners can make significant profits, with annual earnings ranging from $70,000 to over $200,000.

Profitability depends on factors such as the scale of operations, number of patients, service offerings, and efficiency in managing costs.

For example, a chronic care management business managing 200 patients at $50 per patient per month could generate $120,000 annually in revenue from non-complex chronic care management services alone.

Please note that some chronic care management business owners may also generate additional income from remote monitoring, telehealth, and other services that can further enhance profitability.

c. What Factors Determine the Amount of Profit to Be Made?
  • The type of services and the capacity of the chronic care management business
  • The location of the chronic care management business
  • The management style of the chronic care management business
  • The business approach of the chronic care management business
  • The advertising and marketing strategies adopted by the chronic care management business.
  • The number of years the chronic care management business is in business
d. What is the Profit Margin of a Chronic Care Management Business?

The profit margin of a chronic care management therapy is not fixed. To a large extent, after subtracting your overhead, you could make close to 35 percent profit or more.

e. What is the Sales Forecast?
  • First Fiscal Year (FY1): $750,000
  • Second Fiscal Year (FY2): $1.2 million
  • Third Fiscal Year (FY3): $2 million
  1. Set Up your Shop/Office

a. How Do You Choose a Perfect Location for a Chronic Care Management Business?
  • Select areas with a high population of individuals with chronic conditions, such as older adults or communities with prevalent chronic diseases.
  • Locate near hospitals, clinics, and medical offices to facilitate partnerships and referrals.
  • Ensure easy access via public transportation and ample parking for patients and staff.
  • Choose locations with favorable healthcare regulations and reimbursement policies.
  • Assess the level of competition in the area to identify underserved markets and opportunities for growth.
b. What State and City is Best to Open a Chronic Care Management Business?
  • New York City, New York
  • Nashville, Tennessee
  • Atlanta, Georgia
  • Prairie du Sac, Wisconsin
  • Beverly Hills, California
  • Palo Alto, California
  • Miami, Florida
  • Santa Monica, California
  • Houston, Texas
  • Tulsa, Oklahoma
  • New Providence, New Jersey
  • Tinley Park, Illinois.
c. What Equipment is Needed to Operate a Chronic Care Management Business?
  • Examination Tables or Treatment Beds
  • Medical Supplies (gauze, bandages, dressings, etc.)
  • Wound Care Supplies (wound dressings, wound irrigation kits, etc.)
  • Rehabilitation Equipment (therapy balls, resistance bands, weights, etc.)
  • Physical Therapy Modalities (ultrasound machines, TENS units, etc.)
  • Occupational Therapy Aids (adaptive equipment, splints, etc.)
  • Pain Management Equipment (heat therapy devices, cold therapy devices, etc.)
  • Vital Signs Monitoring Equipment (blood pressure monitors, pulse oximeters, etc.)
  • Medical Cart or Trolley for Mobility
  • Diagnostic Equipment (stethoscope, otoscope, etc.)
  • Medical Furniture (chairs, stools, cabinets, etc.)
  • Computer and Software for Electronic Medical Records (EMR)
  • Office Equipment (computers, printers, phones, etc.)
  • Personal Protective Equipment (PPE) for Staff
  • Safety Equipment (fire extinguishers, first aid kits, etc.).
  1. Hire Employees

Hiring employees for a new chronic care management business is essential to ensure efficient operation and quality patient care.

Employees bring expertise in healthcare management, patient communication, and clinical support, enhancing the overall service delivery.

When hiring, look for candidates with relevant qualifications, such as nursing or healthcare administration degrees, as well as experience in chronic disease management and care coordination. It will also be a good idea to prioritize individuals with strong interpersonal skills, empathy, and a patient-centered approach.

Conduct thorough background checks and interviews to assess competency, professionalism, and alignment with the company’s mission and values.

  1. Launch the Business Proper

Organizing an opening party for a new chronic care management business can be a good way to introduce your business to the community and create awareness about your services. However, whether or not to have an opening party is ultimately a decision that depends on your business and goals.

a. What Makes a Chronic Care Management Business Successful?
  • Prioritizing patient needs and preferences, and delivering personalized care plans and support.
  • Establishing clear communication channels between patients, caregivers, and healthcare providers to ensure seamless coordination and collaboration.
  • Offering a wide range of services such as care coordination, remote monitoring, medication management, and patient education to address diverse patient needs.
  • Utilizing advanced technologies like electronic health records (EHR), telehealth platforms, and remote monitoring devices to enhance efficiency and quality of care.
  • Collaborating with healthcare providers, payers, and community organizations to expand service reach, improve care outcomes, and ensure financial sustainability.
b. What Happens During a Typical Day at a Chronic Care Management Business?

A typical day at a chronic care management business involves a variety of tasks focused on providing comprehensive support to patients with chronic conditions.

This includes scheduling appointments, conducting patient assessments, and creating personalized care plans. Care coordinators communicate with patients to address their needs, provide education, and facilitate access to healthcare services.

Health coaches offer guidance on lifestyle changes and medication adherence. Remote monitoring of vital signs and patient data ensures proactive management of health status.

Administrative staff handles billing, insurance claims, and documentation. Collaboration with healthcare providers and ongoing evaluation of care plans ensure continuous improvement in patient outcomes.

c. What Skills and Experience Do You Need to Build a Chronic Care Management Business?
  • Medical expertise
  • Customer services skills
  • Interpersonal skill
  • Accounting and bookkeeping skills
  • Business management skills
  • Attention to details
  • Knowledge of chronic care management or work experience in a chronic care management business environment
  • Experience in managing people
  • Experience in business administration.