Its no secret that care for patients with chronic health conditions are the most costly segment of patients on Medicare, with some 93 percent of Medicare spending going to people with more than one chronic conditions. Enter Chronic Care Management (CCM), Medicare’s attempt to reduce these costs by allowing healthcare providers to offer 20-minute “non-face-to-face” services that might prevent patients’ conditions worsening between office visits, and in turn prevent hospital and/or ER visits.
It sounds like a great idea, but for practices already swamped with time-consuming administrative and compliance requirements, adding another set of requirements might be a tough sell. The core requirement of CCM is a minimum of 20 minutes of non-face-to-face care coordination and management with each patient. Given this mandatory 20-minute consultation, and the fact that practices have on average 300 Medicare patients, 66 percent of which qualify for CCM, the math adds up to not just more hours of consultation time, but the time spent meeting the program’s documentation and billing requirements as well.
Some practices are turning to managed CCM service providers to outsource much or all of the CCM program delivery and administration. CCM service providers have emerged to help practices realize improved patient engagement and quality of care while streamlining billing and reimbursement through the new program (CPT code 99490). These services can help providers meet Medicare’s billing requirements and capture revenue that might have otherwise been missed, at a cost that still leaves room for the practice to realize profits.
CCM service providers help medical practices develop a CCM program that is cost-effective, manageable, and scalable, and that improves patient outcomes and supports new revenue sources without increasing staff or making new technology investments.
CCM service providers can also help practices transition to value-based service delivery as a practice, as CCM is seen as one of the first programs to implement this model.
Some CCM service providers also help practices analyze their patient data to determine the scope of the CCM opportunity for the practice, identify eligible patients, and plan how to document and deliver the required care management services, including implementing things like time-tracking features, modifying EHR records, and creating reporting and billing processes.
The opportunity is for healthcare providers to implement evidence-based processes to improve the outcomes of high-need, high-cost Medicare populations. The ability to enhance population management is important to improve outcomes for patients with multiple chronic conditions. CCM can be an effective, integrated approach to healthcare that can both reduce costs to the system and allow providers to receive compensation that ultimately will offset the rising costs of healthcare.
Using a third party CCM provider allows practices to leverage an existing infrastructure and existing expertise rather than “reinvent the wheel” on its own. Using experienced providers that understand how to communicate with patients and deliver services can work as an extension of a physician’s practice, and can personalize CCM over time and help patients remain motivated informed about how to maintain optimum health.
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