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Care Management ROI: What Practices Can Expect

When practices think about care management ROI, they often focus on billing codes and reimbursement rates. But while claims are vital to the success of care management programs, the practices that see the strongest returns understand ROI is also impacted by retention, prevention, and patient satisfaction.

A program built only to meet billing requirements may technically generate revenue, but it won’t maximize its potential if patients drop off after a few months, if preventive opportunities are missed, or if patients view the program as a burden rather than a benefit. A truly effective and revenue-producing  care management program is designed to create value for the patient and the practice at every step.

In this article, we’ll explore what drives ROI, how to calculate it, where practices can make the greatest impact, and the added value care management delivers beyond financial return.

Understanding care management ROI

Care management ROI is the metric that measures the financial and operational gains a practice achieves from investing in programs such as Chronic Care Management (CCM) and Advanced Primary Care Management (APCM). It serves both as a projection tool, helping your practice anticipate the success of a program, and a performance measure to determine whether the time, money, and resources invested are paying off.

The calculation hinges on two factors: your practice’s upfront investment and the measurable return that follows. Define each clearly before you begin working out the ROI.

Investments

Launching and sustaining care management requires upfront and ongoing investment. These costs go beyond just hiring care managers. Practices must account for:

• Program implementation, including planning, program development, and training.
• Ongoing operations like staffing, patient outreach, enrollment, communication, supplies, and equipment.
• Technology and systems, including EHR integration and reporting tools.
• The administrative work tied to participation in quality programs.
• Care team capacity spent on screenings, education, follow-ups, and documentation.
• External partnerships that support or enhance the program.
• Shutdown costs if an initiative ends or underperforms.

Together, these costs establish the baseline that any returns must exceed for a care management program to generate a positive ROI.

Learn more: The Hidden Costs of In-House Chronic Care Management

Returns

Successful care management efforts typically lead to measurable advantages like:

• Direct reimbursements through CCM, APCM, and related billing codes.
• Fewer readmissions and avoided emergency visits for patients.
• Reduced length of stay for hospitalized patients.
• Lower use of acute and post-acute care for patients.
• Stronger performance on value-based contracts, including quality bonuses and shared savings.

When these benefits outweigh the costs of implementation and operations, the result is a positive ROI that strengthens both financial margins and patient outcomes.

Despite its importance, many practices either don’t know their true ROI, have incomplete data, or even operate at a negative ROI. That lack of clarity can make it difficult to understand whether the program is truly sustainable.

Inaccurate numbers often stem from failing to account for the real costs of program operations or from overestimating how many patients will enroll and stay engaged. ROI is only meaningful if it’s built on realistic forecasts for enrollment, engagement, and retention based on your practice’s resources and experience. Practices that overlook these factors may launch programs expecting strong margins, only to find their returns fall short.

How to calculate ROI in healthcare

Calculating care management ROI starts with a complete picture of costs, savings, and revenue. Program costs include staffing, technology, outreach, and day-to-day operations. What can be harder to identify are the savings and revenue sources, since many of them don’t show up directly on a balance sheet. 

Reductions in emergency visits, shorter hospital stays, and fewer readmissions, for example, all generate savings that contribute to quality performance and therefore ROI, even though they’re not billed as revenue.

Once those numbers are identified, you can apply a simple formula:

ROI = (savings + revenue) - program costs program costs × 100

Subtracting your program costs from the combined savings and revenue determines total cost savings. That figure is then divided by your program costs to show the ratio of what you gained—or lost—relative to your investment. Finally, multiplying by 100 converts the ratio into a percentage, making it easy to interpret your program’s performance.

If the result is greater than 0 percent, the program is profitable. If it’s negative, the program is costing more than it’s returning.

Once you know where your practice stands, the next step is deciding how to improve. With the right strategies, your practice can improve its numbers, turning care management from a cost center into a reliable driver of revenue and outcomes.

Three key pockets for ROI

Care management programs can generate returns in several distinct areas, each requiring a different strategy:

Fee-for-Service (FFS) reimbursement 

Because enrollment drives the billable activity that fuels fee-for-service revenue, practices need a deliberate strategy for getting patients to sign up. Partners such as ChartSpan can help by managing the enrollment conversation and providing patients with materials to introduce the program. Once patients are participating, maintaining their satisfaction and keeping them engaged is essential to preserve revenue and protect ROI.

Accountable Care Organization (ACO) participation

For practices in the Medicare Shared Savings Program or other ACO arrangements, ROI depends on lowering the total cost of care for the patient population. Savings, however, are uneven. For example, the savings from reducing a healthy patient’s annual costs from $9,000 to $8,000 can be negated if a high-risk patient’s expenses rise from $13,000 to $15,000. 

The most reliable way to protect shared-savings revenue is through proactive management of high, medium, and rising-risk patients. Care management particularly addresses patients who are at rising risk to keep them from becoming high-risk. In partial- or full-capitation models, where the practice assumes financial risk if costs exceed benchmarks, investing in prevention is not just good care—it’s the key to maintaining revenue.

Medicare claims-driven revenue for E&M encounters

Care management programs also increase revenue tied to Medicare claims for preventive services. Care managers can direct patients back to the practice for important E&M services, and patients who stay engaged in preventive care generate about $260 more per year on average, thanks to additional visits, tests, and screenings. These added touchpoints boost practice revenue while reducing costly long-term health complications for Medicare as a whole. 

In this way, care management produces a dual payoff: it strengthens the practice’s financial performance and supports better outcomes across the patient population.

6 strategies for maximizing ROI potential with care management programs

Improving ROI isn’t about one-time adjustments; it’s about building sustainable systems that make care management more efficient, more engaging, and more rewarding for both practices and patients. The following six strategies highlight where practices should focus their efforts to achieve the greatest financial and clinical impact.

1. Build the case for your care management program

Before introducing a care management program, start with a solid business case grounded in real data. Practices that rely on optimistic assumptions about patient participation, speed of ramp-up, or immediate savings often find their early ROI projections fall short.

Begin by reviewing at least a year of your own financial and clinical performance metrics to understand your baseline costs and utilization patterns. Then consider what additional costs will come along with care management: additional staff for patient identification, enrollment, and care management; a 24/7 care line; software for documentation and time tracking; and internal processes for when patients need community resources or referrals. If you are considering a partner, this is an ideal time to consider how much they charge for managing the service. 

Use those insights to shape a conservative financial model. Factor in the full range of program expenses—technology, care team time, reporting requirements, and ongoing operations—not just the obvious startup costs. A measured approach lets you refine projections as the program matures and ensures that when you do invest in patient enrollment and engagement, you’re building on a foundation of accurate expectations rather than best-case scenarios.

2. Lay the groundwork with effective enrollment

Enrollment is the first—and often the hardest—step to achieving ROI in care management programs. On average, only about 7 percent of eligible Medicare patients sign up, according to CMS data, leaving most of the potential revenue and clinical impact untapped. Low enrollment squeezes the margin between reimbursements and program costs because fixed expenses must be spread across too few participants.

Several factors make enrollment challenging. Copays are a common hurdle: asking patients to pay for care management each month can deter sign-ups. Yet those who do pay are typically more committed and engaged—engagement that ultimately protects ROI. Net patient churn creates another pressure point. When patients enroll and then drop out, the practice spends more to acquire each retained participant, lifetime revenue shrinks, and onboarding resources are wasted.

To overcome these challenges, set realistic enrollment goals and build a proven process for outreach, consent, and ongoing engagement, or partner with an organization who already has these processes in place. Success requires both sufficient staffing and operational know-how. Practices that dedicate trained staff or partner with an experienced vendor are more likely to meet their targets and sustain ROI. ChartSpan, for example, manages enrollment conversations on behalf of practices and consistently achieves about a 45 percent enrollment rate for primary care practices, helping move eligible patients from unenrolled to participating.

3. Invest in prevention to maximize savings

With nearly 80 percent of practices now participating in some type of Accountable Care Organization (ACO) arrangement, preventive care has become one of the most reliable levers for ROI. The shared savings model rewards reductions in overall patient costs, but those savings aren’t distributed evenly. A small drop in costs for healthier patients can be outweighed if a high-risk patient’s expenses climb, leaving practices with little or no gain.

That’s why true ROI depends on proactive, preventive care—especially for chronically ill, rising-risk, and high-cost patients. In partial- or full-capitation models, where practices assume risk if costs exceed the benchmark, prevention isn’t just a bonus: it’s protection against financial loss. By engaging patients before health issues escalate, practices can close the engagement gap, reduce avoidable utilization, and build a more sustainable path to savings.

4. Use data analytics to target efforts

Data analytics has become one of the most powerful tools for maximizing care management ROI. Descriptive analytics helps practices look backward, uncovering where costs are concentrated and which care pathways have historically led to complications or avoidable utilization. 

For instance, a review of claims and EHR data might reveal that COPD patients with poor medication adherence are consistently driving emergency department visits—information that can guide targeted outreach and intervention. This type of risk analysis is a key component of Advanced Primary Care Management. While care management should be offered to all eligible patients, once they enroll, analytics can help you address their gaps in care and determine what forms of preventive care they need. 

Predictive analytics takes this a step further by forecasting future risks. Machine learning models can identify which patients are most likely to experience avoidable hospitalizations or worsening chronic conditions. By ensuring these patients receive the care management services they need once they’re enrolled in the program, practices can prevent costly escalations, protect shared savings, and strengthen patient outcomes.

In a value-based care landscape, targeting the right patients at the right time with specific preventive care interventions can be the difference between losing money and achieving consistent revenue generation. Data-driven insights ensure that resources are deployed where they make the greatest financial and clinical impact.

If you don’t have these analytical capabilities built into your practice, ChartSpan’s Advanced Primary Care Program can help through detailed patient records and population health analytics. 

5. Prioritize patient experience to drive retention

Patient retention is one of the most overlooked drivers of ROI in care management. Even when enrollment numbers are strong, high churn can quickly erode revenue. Every patient who drops out of care management represents lost revenue and wasted enrollment effort. 

On the other hand, patients who feel supported, heard, and cared for are far more likely to stay engaged and generate consistent reimbursements over time. That’s why practices that partner with ChartSpan gain an advantage. Our team of dedicated care managers build meaningful relationships with patients, engaging them in regular check-ins, helping them build care goals, addressing their gaps in care, and assisting with appointment, medication, or Social Determinant of Health (SDOH) needs. We also provide a 24/7 care line patients can call anytime they have health questions or concerns, even when your practice is closed. 

By providing personalized support, ChartSpan removes common barriers to care while ensuring patients feel prioritized. This frees up the practice’s staff to focus on in-person visits, while patients benefit from consistent communication and attention. The result is stronger engagement, higher satisfaction, and greater retention—each a critical piece in sustaining long-term ROI.

Learn more: Improving the Patient Experience in Healthcare: The Role of Care Management

6. Continuously reassess program costs and performance

Beyond initial planning, care management ROI requires ongoing evaluation. Both costs, such as staffing, outreach, and technology, and outcomes, such as patient engagement, satisfaction, and preventive care utilization, can shift over time. Without consistent monitoring, programs risk drifting off course and losing their financial sustainability.

ChartSpan helps practices maintain alignment by tracking quality measures and monitoring performance on a continuous basis. This visibility allows leaders to identify which strategies deliver the strongest returns, make timely adjustments, and preserve ROI as care management programs evolve.

Value adds of care management beyond ROI

While financial return on investment is a key benchmark, it’s not the only measure of success. Care management programs also deliver value on investment (VOI)—the broader clinical, operational, and human benefits that extend beyond reimbursement. Though often overlooked, these gains can be just as important in evaluating a program’s impact.

VOI shows up in many ways: stronger patient engagement, improved clinical outcomes, and better quality of life for those managing chronic conditions. Patients benefit from consistent education, more accessible care, and personalized support, while practices see higher satisfaction and retention. Care management teams also play an important role in addressing SDOH, which can reduce avoidable utilization and help patients stay healthier in the long run.

Care management also reframes the role of quality and population health teams. Care management has the power to turn what are often seen as cost centers into revenue generators, proving that these teams can drive measurable financial returns. By systematically identifying and addressing care gaps, care managers help your quality team not only improve patient outcomes but also contribute to reimbursement, shared savings, and increased utilization, turning what was once overhead into a meaningful source of financial return.

Care management ROI isn’t automatic. Achieving it requires conservative planning, disciplined enrollment and retention strategies, and a long-term commitment to proactive patient management. Practices that treat ROI as a quick win risk disappointment; those that build carefully and invest in sustainable engagement will realize the true financial and clinical gains these programs can deliver.

How ChartSpan can add value to your practice through CCM

Maximizing ROI from Chronic Care Management depends on consistent enrollment, sustained patient engagement, and efficient program administration. These are the areas where many practices struggle, and where ChartSpan delivers the most value. 

With an average enrollment rate of 45 percent for primary care practices, ChartSpan helps practices capture a larger share of their eligible Medicare population and keep patients engaged through regular outreach and monthly check-ins. That consistency not only strengthens patient relationships but also preserves the recurring revenue streams that make CCM financially sustainable.

Beyond enrollment, ChartSpan’s care managers act as an extension of your team. They build trusted connections with patients, create personalized care plans, provide medication support, schedule follow-up visits, and even arrange transportation when needed. At the same time, ChartSpan tracks quality measures and monitors performance, giving your practice the data it needs to close care gaps, meet program requirements, and uncover new revenue opportunities.

The result is a care management program that feels seamless for both patients and providers. Practices see stronger returns and reduced hospitalizations, patients experience improved access, support, and quality of life, and what was once an administrative burden becomes a reliable driver of growth and better patient outcomes.

Talk to an expert to learn more about how ChartSpan can boost ROI and add value to your practice’s care management program*.

*Revenue may vary by provider.

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• 5 Strategies to Improve the Quality of Healthcare
• The Secrets of Successful Chronic Care Management Training and Onboarding
• Chronic Care Management CPT Codes & Billing Guide