The software of Chronic Care management

In a word - Complexity.  Each Care Manager can be responsible for monthly interaction with each of 200 to 300 patients.  If you only have 1,000 chronic care patients you can probably handle the load with 3-5 nursing FTEs, doing around 12,000 annual care management calls.  

You will need operational and financial dashboarding to keep your executive team easily informed, and to keep your operational team focussed on important trends

Imagine a remote workforce, servicing multiple clinics, using disparate EHRs across your entire population of primary care physicians ... and you'll quickly grasp the value of a centralized tool set.