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Tertiary Prevention: Why It’s Important and How Care Management Can Help

Through preventive healthcare, healthcare professionals strive to improve and protect patients’ health proactively, rather than only responding to new or worsening health conditions. Medicare covers a wide range of preventive health services, and preventive health in general has been shown to lead to lower rates of illness and mortality.

Public health organizations often divide preventive healthcare into three tiers: primary prevention, secondary prevention, and tertiary prevention. Primary prevention, preventing patients from becoming sick or injured, is widely understood. 

However, secondary prevention and tertiary prevention, designed to identify illnesses early and keep conditions from worsening, are also critical for patient health. We’ll discuss the important role primary, secondary, and tertiary prevention each play in healthcare, as well as how care management programs can help you improve your patients’ outcomes through tertiary prevention. 

Primary, Secondary and Tertiary Prevention 

To understand why primary, secondary, and tertiary prevention are all critical for improving patient health, it’s important to understand which strategies fall into each category. 

Primary prevention aims to prevent disease or injury before it occurs. Primary prevention tactics might include vaccinations, programs to encourage exercise and healthy eating, and warnings about the dangers of tobacco. Primary prevention is cost-effective and can greatly improve large-scale health outcomes.

However, even with primary prevention programs, some illnesses or injuries will still occur. This is why secondary prevention and tertiary prevention are important.

Secondary prevention aims to detect illnesses in their early stages, often while the patient is still asymptomatic. This early detection empowers providers to begin treatment as soon as possible and thus improve the patient’s outcome. 

The most common form of secondary prevention is regular cancer screenings. Mammograms, colonoscopies, stool tests, PSA tests, and PAP smears are all forms of secondary prevention. However, other forms of screenings, such as eye exams and blood pressure screenings, can also fall into this category. 

Tertiary prevention occurs when a patient has an ongoing disease or injury that already impacts their life. The goal of tertiary prevention is to reduce the negative effects of the disease or injury, lower the risk of exacerbations, and improve patients’ quality of life and life expectancy.

Examples of tertiary prevention might include:

• Rehabilitation programs after a stroke 
• Support groups
• Therapy for mental health conditions
• Care management programs, such as Chronic Care Management or Advanced Primary Care Management

All three forms of prevention are vital for helping patients manage their health outcomes, but prevention, especially tertiary prevention, is often skipped over for a variety of reasons. 

Challenges for Preventive Healthcare

Healthcare providers are aware of the importance of preventive healthcare, but it can be difficult to implement. One challenge is time and staffing. In-office staff and providers are often overwhelmed by the number of patients they need to provide immediate care for, some of whom are already sick. There isn’t always time to incorporate preventive care during or between appointments.

Sometimes patients also have doubts about the effectiveness of preventive care. For primary prevention, patients may question whether they need a vaccine or to change their nutrition or exercise habits when they appear healthy. When it comes to secondary prevention, patients could avoid or delay uncomfortable screenings if they don’t have symptoms. Some patients also face transportation or scheduling challenges that make it difficult for them to access preventive care. 

Tertiary prevention strategies face different obstacles. Patients are often aware of the need to adjust their nutrition or exercise habits, take their medication regularly, or see their provider to manage conditions they live with. But they may struggle to implement new diet recommendations on a daily basis, to find exercise routines that engage them, to remember their refills, or to reach their provider’s office for appointments.

These struggles especially impact patients with Social Determinant of Health challenges. If a patient can’t afford healthy food or medications, doesn’t have a safe place to exercise, lives in housing with mold or unsanitary conditions, or lacks transportation, their existing chronic conditions are likely to worsen. 

How Practices Can Address Primary, Secondary, and Tertiary Prevention

Providers and clinical staff can incorporate many forms of preventive care into appointments. Some Electronic Health Records have built-in reminders of when patients need immunizations or screenings. This gives clinicians the opportunity to address preventive care when patients come in for unrelated visits.

Rural Health Clinics, Federally Qualified Health Centers, and other practices who serve many low-income patients may also have prebuilt databases of Social Determinant of Health resources. These databases make it easier to direct patients to food pantries or delivery services, housing and utility assistance, transportation agencies, and other vital resources.

However, it can be difficult for practices to follow up with patients when they’re not in the office, especially if practice staff are already overworked. This is where remote care management programs with a partner can help with preventive efforts, especially tertiary prevention efforts. 

Where Does Care Management Fit into Tertiary Prevention?

Care management programs, like Advanced Primary Care Management and Chronic Care Management, provide preventive care outside of in-office visits. Care managers contact patients remotely to:

• Establish care plans
• Set care goals
• Offer Social Determinant of Health resources
• Assist with scheduling appointments
• Help with medication refills

Some care management programs, like Chronic Care Management and Advanced Primary Care Management, also include a 24/7 care line patients can call with questions any time of day. 

Care management programs can help with primary and secondary prevention, but their main impact comes through tertiary prevention. 

Care Management and Primary Prevention

Care management programs can assist with elements of primary prevention. Care managers can encourage patients to receive immunizations for the flu, pneumonia, tetanus/diphtheria, and herpes zoster, as needed.

Some care management programs, such as Advanced Primary Care Management, are available to relatively healthy patients who have no chronic conditions. For those patients, their care managers can help them create proactive exercise and nutrition goals to reduce the risk of illnesses developing.

Care Management and Secondary Prevention

Care managers can also help providers identify serious illnesses early, before they have a chance to progress. For example, ChartSpan’s quality team can identify when eligible patients have a gap in care around breast cancer or colorectal cancer screening. The quality team can then alert the patient’s care manager, who will follow up to provide education on the screening and ask the patient whether they’d like help scheduling one.

Other common forms of secondary prevention included in care management are scheduling eye exams to identify cataracts early, performing cognitive screenings to alert a provider when a patient may need more in-depth examination for Alzheimer’s or dementia, and administering PHQ-2 depression screening so the provider knows if a PHQ-9 may be necessary.

Care Management and Tertiary Prevention

Although Advanced Primary Care Management, Chronic Care Management, and other care management programs can assist with primary and secondary prevention, care management programs are principally focused on tertiary prevention. 

In 2025, Abe Sutton, the director of the Center for Medicare and Medicaid Innovation, stated that tertiary prevention is an area where CMMI wants to invest. Therefore, the Centers for Medicare and Medicaid Services will likely continue to support care management programs that focus on conditions patients already have to prevent exacerbation or decline. 

CMS’s commitment to tertiary prevention is reflected in their continued support for Chronic Care Management from 2015 to the present day and in their introduction of Advanced Primary Care Management. 

Chronic Care Management (CCM) is only available to patients who already have two or more chronic conditions.Launched in 2025, APCM brings tertiary prevention to patients with one chronic condition or patients who have no conditions but may develop them in the future. 

Specific Ways CCM and APCM Support Tertiary Prevention 

Tertiary prevention has a critical role to play for patients enrolled in APCM or CCM. When patients have a personalized care plan designed to manage their chronic conditions, with achievable care goals around nutrition, exercise, smoking cessation, stress reduction, and more, they can lower their healthcare costs and achieve fewer hospitalizations. 

ChartSpan Chronic Care Management has reduced healthcare costs by $2,457 per patient, per year and hospitalization costs by $889 per patient, per year, according to Medicare claims data. Although APCM is a newer program, it’s expected to produce many of the same effects. 

In addition to assisting with care plans and care goals, care managers can help patients schedule appointments, refill their medications, and find transportation to upcoming in-office visits. Through APCM, care managers can also follow up as soon as patients are discharged from the hospital to address any questions they have, help them find needed medications, and encourage them to schedule a visit with their provider. 

Both APCM and CCM also support patients by directing them to Social Determinant of Health (SDOH) and community resources. While some practices have established databases of SDOH resources, others may not have time to assemble them or may struggle to share them with patients after-hours. 

During regular monthly check-ins, care managers can survey patients about their food, housing, transportation or safety needs and provide them with local resources. If patients need resources immediately, they can reach out through the 24/7 care line for help, even at night, on the weekend, or during national holidays. 

By providing such a wide array of resources, APCM and CCM programs reduce costs for Medicare patients and help them achieve fewer hospitalizations and better management of their conditions: the goal of tertiary prevention. 

The Impact of Care Management for Tertiary Prevention

While primary, secondary, and tertiary prevention are all important, tertiary prevention is often overlooked. Even after patients have developed chronic illnesses, helping them live longer, healthier lives and prevent exacerbations, hospitalizations, or dramatic decline is still an important goal for practices and health systems. 

Care management programs directly address patients who can benefit from tertiary prevention, offering them personalized care plans and goals, dedicated care managers, and abundant resources to help them manage their health and prevent their conditions from worsening. If you’d like to learn more about how different care management programs can serve your preventive healthcare goals, check out our Guide to the Evolution of Care Management.