Medicare’s Chronic Care Management program pays providers to check in with chronically ill patients between visits. Boris Dobrin says the biggest obstacle to enrollment isn’t the program itself. It’s everything around it.

Medicare has been paying providers for chronic care management since 2015. The math on eligibility is striking: roughly two-thirds of Medicare beneficiaries live with two or more chronic conditions, the threshold for CCM enrollment. That translates to tens of millions of eligible patients.

Actual enrollment tells a different story. Federal evaluations and independent studies have consistently found that only a small fraction of eligible beneficiaries, by most estimates in the single digits as a percentage, receive billed CCM services in a given year. According to a 2025 analysis by Avalere Health, only a fraction of eligible beneficiaries have enrolled in a CCM program, with one study putting uptake below 4% of eligible enrollees in 2019, even as utilization of CCM codes grew at an average annual rate of 7.4% from 2019 to 2023. A decade into the program, the gap between who could benefit and who is enrolled remains one of the most persistent puzzles in Medicare.

Boris Dobrin, founding leader of chronic care management platform CareSpace, argues the gap has little to do with the value of the program. “When you look at what CCM actually delivers, fewer emergency visits, better medication adherence, a care team that answers the phone, patients want that,” says Dobrin. “The enrollment problem is a friction problem. It lives in awareness, in cost conversations that never happen well, and in practices that don’t have the operational muscle to run the program.”

Why Don’t Patients Know About CCM?

The first barrier is the simplest: most eligible patients have never heard of the program. CCM is not something patients sign up for through Medicare directly. Enrollment starts with a provider explaining the service and obtaining consent, which means the program only reaches patients whose practices actively offer it.

Even when the conversation happens, the pitch can fall flat. Care coordination is largely invisible work. Patients can picture an office visit or a procedure. A nurse reviewing their medication list, updating a care plan, and coordinating with a cardiologist behind the scenes is harder to visualize, and harder to value.

“Nobody wakes up wanting care coordination,” says Dobrin. “They want to stay out of the hospital. They want someone to call when a new symptom shows up on a Saturday. Practices that frame CCM around those outcomes enroll patients. Practices that read a compliance script don’t.”

Does Cost Sharing Keep Patients Out?

CCM is a Medicare Part B service, which means patients without supplemental coverage owe 20% coinsurance. At 2026 national payment rates, that works out to roughly $13 a month for the base non-complex code. It’s a modest amount, but it’s a recurring charge for a service the patient may not fully understand, and for beneficiaries on fixed incomes, any new monthly bill invites scrutiny.

Dobrin notes that the cost conversation is often mishandled rather than genuinely prohibitive. Many beneficiaries carry Medigap or Medicaid coverage that reduces or eliminates the coinsurance entirely, and dually eligible patients typically owe nothing out of pocket. According to the Centers for Medicare and Medicaid Services, more than 8 million people, better than 1 in 8 Medicare beneficiaries, were enrolled in the Qualified Medicare Beneficiary group as of 2023, and those beneficiaries have no legal obligation to pay Part A or Part B deductibles, coinsurance or copayments. “A lot of patients decline CCM over a copay they would never actually pay,” he says. “If the front desk can’t answer the question ‘what will this cost me,’ the enrollment ends right there.”

The comparison that resonates, Dobrin adds, is what the alternative costs. A single avoidable emergency room visit can run a patient hundreds of dollars out of pocket even with coverage. Measured against that, a monthly coinsurance charge smaller than a pizza starts to look like insurance against something far more expensive.

Why Do Practices Hesitate to Offer CCM?

The other half of the enrollment gap sits with providers. Running a compliant CCM program requires documented patient consent, a comprehensive electronic care plan, 24/7 access to the care team, and careful tracking of clinical staff time each month. For a small practice already stretched thin, that can read like a second job.

Common sticking points include:

  • Practices worry about audits and clawbacks if time logs or consent documentation fall short, so they avoid billing the codes altogether.
  • Physicians assume they must personally deliver the service, when Medicare allows clinical staff to perform non-complex CCM under general supervision.
  • Reimbursement rates, historically, made the return on investment feel thin once staffing and administrative costs were counted.
  • Nobody in the practice owns the program, so enrollment happens opportunistically instead of systematically.

The 2026 Medicare Physician Fee Schedule softened at least one of those objections, raising reimbursement for all CCM-related CPT codes by roughly 8% to 11%. Dobrin has argued the increase matters less as a windfall than as a margin cushion that makes properly staffed programs pencil out.

What Actually Closes the Gap?

Dobrin’s prescription is to treat enrollment as a workflow rather than a hope. That means identifying eligible patients from the practice’s own panel data, building the CCM conversation into annual wellness visits and routine appointments, training staff to explain benefits and out-of-pocket costs in plain language, and using technology to handle the time tracking and documentation that scare practices away from billing.

“The practices that succeed don’t have more persuasive doctors,” says Dobrin. “They have a system. Every eligible patient gets asked, every consent gets documented, every minute gets logged without the staff thinking about it. When the operational fear goes away, enrollment follows.”

The patients, he argues, were never the hard part. “Ask a 74-year-old managing diabetes and heart failure whether she’d like a nurse checking in every month, and the answer is almost always yes. Our job is making sure someone actually asks.”