The Chronic Care Model and the Transformation of Primary Care

  • Thomas BodenheimerEmail author
  • Rachel Willard-Grace


To address inadequacies in the management of chronic illness, the chronic care model (CCM) was developed to transform primary care practices so that they could initiate and sustain improvement in chronic care. The CCM consists of six components—community resources, health system policies, decision support, delivery system design, clinical information systems, and self-management support. This chapter describes these components and summarizes evidence supporting their efficacy. The chapter then proposes a broader model—the 10 Building Blocks of High-Performing Primary Care—that helps primary care practices make the changes necessary to implement the CCM components.


Chronic care Primary care 



Chronic care model


Electronic medical record


Hemoglobin A1c


National Committee on Quality Assurance


Patient-centered medical home


Registered nurse


Type-2 diabetes


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Family and Community MedicineUniversity of California, San FranciscoSan FranciscoUSA

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