Principal Care Management (PCM) - Intensive Disease Management

Principal Care Management for Complex Conditions

Principal Care Management (PCM) provides intensive care coordination for Medicare beneficiaries with a single high-risk chronic condition expected to last at least three months. PCM is designed for patients whose complex conditions require substantial care management—such as advanced heart failure, COPD requiring oxygen, uncontrolled diabetes with complications, or cancer treatment. Unlike CCM which requires multiple chronic conditions, PCM focuses on patients with one serious condition requiring significant clinical attention.

Our PCM platform supports the enhanced care coordination these patients require, including comprehensive care planning, frequent patient contact, coordination with specialists, medication management, and 24/7 access to care teams. The system tracks the 30-minute minimum monthly requirement for PCM billing (CPT 99424, 99425, 99426, 99427) with detailed time logs and activity documentation. Care coordinators can manage hospital transitions, arrange home health services, coordinate durable medical equipment, and ensure patients understand complex treatment regimens. The platform integrates with RPM and RTM for patients who benefit from continuous monitoring alongside intensive care coordination.