The effort to meet patients where they are is driven by the additional goal of reducing unnecessary hospitalizations and costs. As care management continues to expand, several key trends are shaping the future of these essential services. These include an increased focus on social determinants of health (SDOH) which can limit access to patient care. The creation of new billing codes allows organizations to capture and be reimbursed for the non-medical aspects of coordinating and supporting whole patient care.
One of the most significant recent developments in care management is the creation of new billing codes to capture the work done to support patients in non-medical settings. These new codes reflect the growing recognition that much of the work of care management takes place outside of traditional clinical settings and that this work is vital for helping patients achieve their healthcare goals.
The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) have introduced new Current Procedural Terminology (CPT) codes to better account for the time and effort that care managers spend coordinating care, addressing SDOH, and engaging in face-to-face activities such as patient education, resource coordination, and care planning. These codes ensure that healthcare providers are reimbursed for the full range of services they provide, beyond direct medical care.
New codes for Community Health Integration were created to capture activities to address social determinants of health (SDOH) needs that significantly limit the ability to diagnose or treat problems that are addressed by the physician or other practitioner directing patient care in an initiating visit.
Principal Illness Navigation service codes were created with the intention of developing a framework to support patients through serious, high-risk conditions. The use of Peer Support Specialists in these code descriptions provides resources for patients with high-risk behavioral health conditions.
The importance of mental health and SDOH in patient care has also been recognized, and with the addition of these new codes, has created a pathway for organizations to be reimbursed for the significant efforts of staff working with patients on issues such as stress management, behavioral change, and access to social services; all of which are essential for improving long-term health outcomes.
The scope of care management has grown considerably in recent years, moving beyond the management of purely clinical conditions to a more holistic approach that addresses the full spectrum of a patient's needs.
One of the most recent trends in care management is the focus on personalized, patient-centered care. Care managers are no longer just coordinating clinical treatments. They help patients navigate their entire healthcare journey, addressing both medical and non-medical needs. This patient-first approach aims to empower individuals to advocate for their own healthcare needs and become active participants in their care.
Digital health tools are increasingly being integrated into care management programs. Platforms that offer real-time communication such as audio-only or telehealth visits have now become an everyday practice over the last five years. There has also been an increase in remote patient monitoring, and mobile health apps to help care teams maintain continuous communication with patients, track their progress, and support early intervention when needed. This is particularly important for patients with chronic diseases, where proactive management can prevent complications and reduce healthcare utilization.
Another significant trend is the use of interdisciplinary care teams, which may include primary care physicians, specialists, nurses, social workers, dietitians, and other healthcare professionals. This collaborative approach allows for more comprehensive and coordinated care, addressing the varied needs of patients, especially those with multiple conditions.
In conclusion, care management services are undergoing a transformation as governing bodies such as AMA and CMS increasingly recognize the importance of addressing the whole patient, not just their clinical conditions. By focusing on patient-centered care, integrating technology, and addressing social determinants of health, care management is evolving into a comprehensive patient support system.
The creation of new billing codes further reflects this shift, ensuring that healthcare organizations are compensated for the essential work they do in non-medical settings. As these trends continue to develop, care management will likely play an increasingly critical role in helping patients achieve their healthcare goals and improve their quality of life.
Published: 12/07/2025
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