Transform Chronic Care with Smart, Scalable CCM Software

Empower your care teams to deliver consistent, high-quality chronic care. Vervelo’s end-to-end Chronic Care Management platform simplifies patient monitoring, automates documentation, and ensures compliance with Medicare CPT billing.
Chronic-Care-Management
Chronic Care Management Software – Built for Better Outcomes
Vervelo’s Chronic Care Management (CCM) software is designed to help healthcare providers deliver coordinated, patient-centric care for individuals with multiple chronic conditions. Our platform streamlines the entire CCM process—from patient enrollment to Medicare-compliant billing—so you can improve health outcomes while driving practice efficiency and revenue.

We empower care teams to create customizable care plans, conduct proactive health monitoring, and automate recurring tasks like documentation, communication, and reporting. With seamless EHR integration, HIPAA compliance, and support for CPT billing codes, Vervelo’s CCM solution is trusted by providers looking to scale chronic care programs without operational friction.

Key benefits include:

  • Enhanced patient engagement with secure portals and education tools

  • Seamless remote monitoring through connected health devices

  • Automated compliance tracking and audit-ready documentation

  • Built-in workflows for CPT 99490, 99439, 99487, and related codes

Whether you’re a clinic, hospital, or care network, our platform helps you deliver consistent, high-quality care that aligns with the goals of value-based healthcare.

Key Features of Our Chronic Care Management Software

Personalized & Scalable Care Plan Management

Design, assign, and manage customized care plans for patients with multiple chronic conditions such as diabetes, COPD, hypertension, heart disease, and more. Our platform supports template-based protocols, goal tracking, and adaptive regimens—making it scalable for small practices and enterprise care networks alike.

Built-In Medicare CPT Code Billing Support

Automate billing for CPT 99490, 99439, 99487, 99489, and other relevant chronic care codes. Vervelo ensures time-based tracking, task logging, and audit-friendly documentation, enabling seamless Medicare reimbursement with full regulatory alignment.

Real-Time Health Monitoring with IoMT Integration

Enable remote patient monitoring with out-of-the-box support for IoMT devices, including glucometers, BP monitors, pulse oximeters, and ECGs. The platform captures live vitals, flags abnormalities, and triggers alerts for care team intervention.

Seamless EHR and Clinical System Integration

Vervelo integrates with popular EHR platforms through FHIR and HL7 standards, ensuring bidirectional data flow, elimination of double entries, and real-time documentation updates across all points of care.

HIPAA-Compliant Patient Communication Tools

Connect with patients through secure messaging, real-time audio/video consultations, and automated appointment reminders, all fully encrypted and compliant with HIPAA, GDPR, and CCPA data privacy protocols.

Intelligent Task Automation & Workflow Engine

Our smart automation system reduces manual workload by automating routine clinical tasks, sending customizable alerts, and providing care coordination workflows tailored to each provider’s delivery model.

Centralized Dashboard for Care Teams

Get a real-time 360° view of patient data, engagement levels, overdue tasks, and clinical priorities. Care teams can triage by risk level, assign responsibilities, and collaborate across departments or clinics.

Patient Engagement & Self-Care Tools

Drive better outcomes by empowering patients with interactive care plans, educational resources, secure messaging, and goal tracking dashboards—available across mobile, tablet, and web interfaces.

Advanced Analytics & Population Health Insights

Leverage AI-driven analytics to monitor patient trends, identify high-risk groups, and generate care performance metrics that support value-based care initiatives and quality reporting (e.g., MIPS, ACO).

Multi-Site, Multi-Provider Scalability

Whether you're operating a single clinic or a nationwide network, our platform supports multi-location deployment, role-based access control, and custom branding—ensuring flexible deployment across health systems, ACOs, FQHCs, and telehealth providers.

Use Cases of Chronic Care Management Software Across Healthcare
Vervelo’s Chronic Care Management Software helps providers across primary care, specialties, and value-based care deliver personalized, remote care with ease. With support for real-time monitoring, automated compliance, and CPT-based billing, it streamlines chronic care delivery while improving outcomes and operational efficiency.

Primary Care & Family Medicine

  • Chronic disease management for conditions like diabetes, hypertension, asthma, and arthritis

  • Personalized care plans auto-synced with EHR for seamless documentation

  • Automated reminders and follow-ups to boost patient compliance

  • Support for CPT code billing (e.g., 99490, 99439) to increase reimbursement

Cardiology Practices

  • Remote monitoring of heart failure, post-stent recovery, and arrhythmia patients

     

  • Real-time integration with ECG, BP monitors, and heart rate sensors

     

  • Alert-driven workflows for early intervention and reduced hospitalizations
  • Consolidated dashboards for multi-provider cardiac teams

Endocrinology & Diabetes Management Centers

  • Monitor and manage patients with Type 1, Type 2, and gestational diabetes

  • Integration with glucose monitors and smart insulin devices

  • Educate patients through self-care modules and progress tracking tools

  • Enable customized insulin titration plans and daily vitals review

Pulmonology & COPD Clinics

  • Track patients with chronic respiratory conditions like COPD and asthma

  • Real-time vitals from spirometers, pulse oximeters, and inhaler sensors

  • Alerts for abnormal SpO2 levels, breath rate, and exacerbation indicators

  • Actionable analytics to support personalized respiratory therapy

Geriatric & Long-Term Care Facilities

  • Manage high-risk seniors with multiple comorbidities under a unified dashboard

  • Coordinate between providers, caregivers, and specialists for holistic care

  • Auto-generate reports for care plan reviews and regulatory audits

  • Enable HIPAA-compliant messaging with family members or POAs

Value-Based Care Networks & ACOs

  • Monitor patient populations for risk stratification and care quality metrics

  • Align care activities with value-based reimbursement models

  • Use predictive analytics to reduce readmissions and ER utilization

  • Automate documentation for CMS audits, MIPS, and HEDIS reporting

Telehealth & Remote Clinics

  • Deliver chronic care services remotely with secure video calls and real-time vitals

  • Empower care coordinators with mobile-first dashboards and alerts

  • Onboard patients virtually through e-consent and remote enrollment flows

  • Reduce care gaps and extend access to underserved or rural populations
Our Chronic Care Management Services
At Vervelo, we offer a full suite of chronic care management services designed to improve patient outcomes, streamline provider workflows, and align with value-based care models. Our solutions are built to support scalable, secure, and connected healthcare delivery for diverse clinical environments.

Custom Care Plan Development

  • Create structured, individualized care plans for chronic conditions such as diabetes, hypertension, COPD, and more.

    • Tailor plans using clinical history, comorbidities, and patient goals

    • Enable dynamic care workflows with automated checklists and thresholds

    • Improve adherence through milestone-based engagement

Our platform allows providers to design care plans that are flexible, evidence-based, and directly aligned with each patient’s health journey.

24/7 Remote Patient Monitoring (RPM)

  •  Enable real-time health tracking with connected IoMT devices.

    • Continuously monitor vitals like BP, glucose, SpO2, weight, heart rate

    • Trigger automated alerts for abnormal readings

    • Reduce ER visits with early interventions and proactive care

Stay connected to your patients beyond clinic walls—track vitals remotely, catch issues early, and improve the quality of chronic condition management.

CPT-Compliant Care Coordination

  •  Support billing and documentation for Medicare CPT codes such as 99490, 99439, and 99457.

    • Automate time tracking and care activity logs

    • Ensure easy reporting with CMS audit readiness

    • Maximize revenue opportunities from chronic care services

Our tools help you maintain regulatory compliance, simplify documentation, and drive consistent reimbursements through structured coordination.

Secure Virtual Consultations & Messaging

  •  Deliver care beyond clinic walls with HIPAA-compliant communication tools.

    • Offer real-time video calls and asynchronous messaging

    • Document consults directly into EHR

    • Improve care continuity for high-risk and homebound patients

Empower patients and care teams to communicate efficiently with secure, reliable, and integrated telehealth features.

 

EHR & Third-Party System Integration

  •  Integrate seamlessly with existing health IT infrastructure.

    • Use standards like FHIR, HL7, DICOM, CCDA

    • Reduce redundancy with automated data sync

    • Support interoperability across care teams and platforms

Ensure a unified patient view and eliminate manual data entry with plug-and-play integrations that fit into your existing ecosystem.

Patient Education & Self-Management Tools

  •  Equip patients to actively manage their chronic conditions.

    • Share condition-specific educational content and care tips

    • Use goal tracking dashboards and reminders

    • Enhance engagement and health literacy

Increase patient confidence with tools that encourage active participation and foster better self-care habits.

Population Health & Predictive Analytics

  • Drive smarter care decisions with real-time insights.

    • Stratify patients by risk using clinical and behavioral data

    • Track trends across populations for quality improvement

    • Align with value-based care models and ACO goals

Leverage AI-driven analytics to deliver proactive, personalized care at scale—optimizing both clinical outcomes and operational efficiency.

Leverage AI-driven analytics to deliver proactive, personalized care at scale—optimizing both clinical outcomes and operational efficiency.
Why Fine-Tune Pretrained AI Models?

End-to-End Chronic Care Expertise

From care planning to RPM integration, our team understands the full spectrum of chronic care workflows. We build systems that match real-world care delivery needs—not just software specs.

Medicare & CPT Compliance Built-In

Our platform is pre-configured to support Medicare-approved billing codes (e.g., 99490, 99439), time tracking, and audit logs. Ensure billing accuracy and simplify reimbursement processes from day one.

Deep Integration Capabilities

Seamlessly connect with EHRs, IoMT devices, and third-party systems using standards like FHIR, HL7, and CCDA. Maintain a single source of truth and eliminate manual data silos.

Secure & Scalable Architecture

Hosted on HIPAA-compliant, cloud-native infrastructure with support for GDPR, ISO 27001, and role-based access. Deliver safe, reliable care to 100 or 100,000+ patients—without compromising performance or privacy.

Modular, Customizable Platform

Configure workflows, alerts, programs, and dashboards to match your clinical model. No need to adapt your care delivery to rigid templates—we tailor the tech to you.

Proven Results Across Healthcare Settings

From independent providers to large health systems, our platform has powered better outcomes and operational efficiency. Improve patient satisfaction, increase revenue potential, and reduce hospital readmissions.

Contact Us
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At Vervelo, we deliver seamless integration and performance-driven solutions that move your business forward in the digital age. Share your vision—we’re here to bring it to life.
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Frequently Asked Questions

 Chronic Care Management (CCM) software is a digital solution that enables healthcare providers to deliver coordinated, continuous care to patients with multiple chronic conditions. It helps automate workflows, track patient vitals, manage care plans, and comply with CMS billing requirements like CPT 99490, 99439, and 99487.

Vervelo’s CCM platform is ideal for clinics, hospitals, primary care providers, ACOs, and telehealth networks aiming to improve outcomes for patients with conditions such as diabetes, hypertension, COPD, or heart failure.

 Yes. Our software supports CMS-compliant billing workflows and tracks time-based services required for Medicare CPT codes like 99490, 99439, and 99487. It generates audit-ready reports and simplifies documentation for reimbursement eligibility.

Absolutely. Vervelo’s CCM software offers seamless integration with major EHR platforms, enabling smooth data exchange, automated patient syncing, and continuity in care documentation.

We provide HIPAA-compliant communication tools, such as secure messaging, patient portals, and mobile-friendly care plan access, allowing patients to stay informed, track their progress, and engage actively in their treatment journey.

 Yes. Our solution integrates with IoMT devices and wearable health trackers to enable real-time remote monitoring of vitals like blood pressure, glucose, oxygen levels, and more—ensuring proactive intervention and better care coordination.

The software is configurable for a wide range of conditions including diabetes, asthma, arthritis, heart disease, chronic kidney disease, obesity, and mental health disorders—with customizable care plans and tracking protocols.

 Yes. Vervelo offers full onboarding, platform training, and technical support to ensure a smooth implementation for your care teams and staff.

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Email us at sales@vervelo.com – we’re happy to help!
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