Chronic conditions do not wait for a convenient quarter to roll around. A patient’s asthma flare, missed medications, rising A1c, or repeat emergency department visit can turn into a hospitalization fast — especially for people navigating complex lives and limited resources. That is why we continue to invest in proactive chronic care that meets patients where they are, while keeping value-based care practical for busy practices.
In our Equality Care Incentive Program (ECIP), we have seen what happens when practices get the right patients on the right radar at the right time: fewer avoidable hospitalizations, stronger quality performance, and better patient outcomes. Chronic care member management has been a key lever because high-risk patients account for most potentially avoidable utilization and cost, and proactive, data-driven touchpoints can move outcomes quickly.
Now, for 2026, we are expanding our approach.
What’s Changing: From “High-Risk” to Earlier Chronic Care Action
Starting in 2026, EH is broadening the Chronic Care Management (CCM) incentive — moving beyond the prior high-risk member management definition so more patients can qualify, earlier. The goal is simple: help you intervene sooner, before risks become crises.
Eligible chronic conditions will be based on National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) value sets and include:
- Asthma
- Behavioral health conditions
- Cardiovascular disease
- Chronic obstructive pulmonary disease (COPD)
- Diabetes
- Hypertension
How Patients are Identified: Ongoing, and Tied to Real-World Risk
Instead of identifying eligible patients at a single point in time, CCM eligibility will be identified on an ongoing basis. This means a patient may become eligible as new risk signals emerge.
A qualifying event is an adverse clinical event. Patients with an eligible condition may be automatically identified when they experience things like:
- Multiple emergency department visits
- Uncontrolled lab values
- Lack of medication adherence
This is designed to support earlier identification and intervention — before the next avoidable emergency visit or admission.
What You Need To Do: A Standard Visit, in the Same Month
CCM is meant to reduce administrative burden, not add to it.
To close the CCM measure and earn the incentive, you simply need to see the patient in the office within the same calendar month that the measure opens in the CareEmpower® worklist. A standard office visit counts — submit your typical office visit billing code for that encounter. No special CCM billing code is required to receive ECIP credit. No additional documentation uploads or “required activities” are needed to earn CCM credit.
What Stays the Same: Practical Support, Backed by CareEmpower
Your workflow support in CareEmpower still matters — from identifying patients who need attention to acting on the next best step. And the best practices you already use in high-touch visits still apply: review adherence, order indicated labs, and close key preventive screening gaps when appropriate.
EH is also continuing to strengthen the support around these visits, including easy referrals to our care team through CareEmpower and physician-led chart review feedback focused on patient safety, advance care planning, and chronic disease management opportunities.
Why This Matters For Your Practice
This shift is about being Dedicated to Better — better outcomes for patients, and a simpler, more workable path to value-based performance for providers. CCM expands the incentive to match the reality you see every day: chronic care needs timely action, not more paperwork.
