Chronic Care Management (CCM) was introduced by Medicare in 2015 as a program to lower the cost of caring for people with multiple chronic health conditions like diabetes or heart disease. The program reimburses doctors for “non-face-to-face” services twice per month, aiming to reduce complications, office visits, and hospital stays by keeping on top of a patient’s care.
Deductible Challenges Adoption
A snag in the plan makes it difficult for people with higher deductible insurance plans to use CCM before their deductibles are met. Currently, insurance plans can cover only certain preventative services like immunizations and screenings for blood pressure or cholesterol without cost sharing before a deductible is met. A bipartisan bill introduced in Congress in July would allow high-deductible health insurance plans that can link to health savings accounts (HSA) to cover CCM, which would add services for managing chronic illnesses to that list.
More and more people are using higher deductible insurance plans as healthcare costs soar, paying lower premiums in exchange for more out of pocket expenses. The hope for insurers has been that higher deductibles will force patients to be smarter and more prudent in their use of healthcare services. HSAs, where consumers stash away pre-tax money with or without employer matches were introduced in 2004. The accounts must be linked to health plans that meet certain federal standards, including minimum deductibles of $1,300 for individuals and $2,600 for families in 2016.
According to Families USA, more than 40 percent of adults have plans with deductibles of $1,500 or more. The Centers for Disease Control estimates that about 86 percent of healthcare spending is on chronic conditions. Combine those numbers and you have the potential for a lot of out of pocket expenses for patients with chronic conditions and high deductibles.
While it was thought that high deductible health plans would drive patients to make better decisions about their care, sometimes the opposite happens. Patients fail to access services that might keep them out of the hospital because of the high cost of the service, and the fact that they are responsible for paying it prior to reaching deductible limits. Insurers don’t want patients going to the emergency room every time they stub a toe, but they do want to prevent more serious conditions from developing, which is why they cover preventative services.
The Ultimate Preventative Health Care
CCM is arguably the ultimate preventative health service. According to the U.S. Department of Health and Human Services (HHS), “nearly 20 percent of Medicare patients discharged from hospitals were readmitted within 30 days for an exacerbation of the diagnosed condition. Nearly one-half of the readmitted patients had no postdischarge contact with healthcare professionals.” Chronic disease management can reduce hospital readmissions and lower health care costs.
The HHS points out that, “A typical patient with multiple chronic medical conditions cycles in and out of the hospital and the emergency department; sees multiple specialists; and may take as many as 12 to 14 medications, some of which may be duplicative or unnecessary. The problem is that the delivery of care is fragmented, and the old-fashioned fee-for-service payment system encourages and perpetuates the delivery of care in silos.”
CCM solves this problem in two ways. First, as mentioned, regular check-ins will help prevent conditions worsening due to lack of doctor-patient interaction. Secondly, CCM providers must communicate and track all of a patient’s medical care from other doctors, facilities, pharmacists, and therapists. This can help prevent medication mismanagement, and ensure that the medical right-hand knows what the medical left hand is doing.