Centera Health runs Chronic Care Management for roughly 18,000 patients across twelve primary-care clinics. Before 31M, each clinic kept its own spreadsheet: different columns, different cadences, different ideas of what "enrolled" meant. The care-management leadership had no reliable way to answer two questions every CCM program needs to answer monthly: which patients are billable, and which patients are at risk of slipping out of the program.
The challenge
Care managers were spending the first week of every month reconstructing what had happened the month before. Time logs lived in three different formats, consent dates were inconsistent, and reconciling against billing required a person to read each row by hand. The team estimated that 20–30% of eligible patients weren't being billed simply because the documentation couldn't be assembled in time.
What changed on 31M
Centera moved every clinic onto one shared CCM worklist. Care managers now see the same view of every enrolled patient regardless of which clinic the patient is attributed to, with per-interaction timers replacing the end-of-month spreadsheet entries.
- One worklist sorted by next-touch due date, not by clinic.
- Per-interaction timers that roll up to monthly totals automatically.
- Consent and care-plan history stored as first-class records, surfaced inline on the patient profile.
- A monthly audit export that pairs every billable patient with their time log, consent timestamp, and care-plan revision.
Results
Within six months, billable-patient counts rose 38%. Most of the lift came from patients who were already enrolled but had been falling through documentation gaps. Care-manager throughput roughly doubled because the monthly reconciliation work disappeared. Centera's billing lead now signs off on the month-end report in an afternoon instead of a week.