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Background Care management has the potential to improve quality of care and health outcomes for chronic conditions, but questions remain about how patients perceive care management. Understanding patient perceptions is critical for ensuring care management can successfully engage patients and improve management of chronic conditions. Objective To understand high-risk patients’ experiences and perceptions of care management. Methods We conducted 1-h phone interviews with 40 patients receiving care management at 12 practices participating in the Centers for Medicare & Medicaid Services Comprehensive Primary Care Plus model. Interviews were transcribed verbatim and analysed using a thematic approach. Results Most patients reported discussing health goals with their providers that aligned with their values and care preferences; a few reported that goal setting did not result in desired action steps. Most reported positive experiences receiving behavioural health support; a few reported unmet behavioural health needs that they had not expressed to their practice. Patients reported financial and transportation barriers to following care managers’ recommendations. Care managers’ active listening skills, accessibility, and caring personalities facilitated patient engagement. Conclusions Practices should consider patient perspectives as they improve care management activities. Future research is needed to confirm our findings about patient perspectives regarding goal setting, behavioural health support, and barriers and facilitators to engagement.