According to the Center for Medicare and Medicaid Services (CMS), 45 million of the 60 million eligible Medicare beneficiaries have 2 or more chronic conditions. These conditions affect a patient’s quality of life. They are often complex, costly, time-consuming to manage and frequently require after hours care. Independent studies indicate that primary care physicians are not equipped to manage chronic care, which leaves these patients abandoned until an acute episode of illness causes them to return to the doctor’s office or hospital.
CMS launched the Chronic Care Management program in 2015 to address this growing Medicare problem. New CPT codes were created and reimbursement rates, that are based on the amount of time spent during patient encounters, were meant to serve as an incentive for doctors to provide these needed services. The amount of work required to meet CMS regulations, and the level of reimbursement for the few new services covered, has not proven to be a sufficient incentive for doctors to provide CCM services. However, when managed correctly, shifting to a value-based chronic care solution creates a model that works better for everyone, and we explain why. Here are our top 10 reasons why you should consider CCM for your practice:
1. CCM Delivers Optimal Care for Chronic Patients
The first, and probably most important reason why you should consider a value-based CCM program is it allows practices to have the capacity to improve clinical outcomes and quality of life for patients with two or more chronic diseases. One of Medicare’s CCM requirements is requiring the use of telehealth technology to provide care for patients in between their doctor visits. Supplemental access to a care provider during gaps in care provides consistency to treatment, which is key to managing chronic diseases. Depending on a patients’ risk evaluation, a care provider could work with patients for 20 minutes, 40 minutes, or even 60 minutes, as needed.
2. The Number of Patients with Chronic Diseases is Growing
There are currently 140 million people living with chronic diseases in the United States. For the elderly, the situation is even more dire. 3 out of 4 people aged 65+ are afflicted with two or more chronic illnesses who require care. This is already a serious situation and will only get worse as chronic cases will increase in the coming years, putting a terrible strain on our healthcare system. By 2025, a staggering 49% of the population will have at least one chronic illness. This number is projected to increase by more than one percent each year through 2030.
3. Decreased Workload and Non-billable Time
Implementing a CCM program in your practice, especially if you consider partnering with a company that can handle the CCM care delivery for you, means no longer having to follow-up potentially up to 60 minutes a month per chronic patient. Not only does that free up a lot of time for you and your staff to focus on other things, but it also translates into a reduction in non-billable time for your practice.
4. Generate New Revenue for Your Practice
Implementation of an efficient CCM program will mean achieving quality measures in-patient experience of care, care coordination, patient safety, and preventative health. Achieving these measures will yield significant population health revenue for your practice. The amounts reimbursed by Medicare will depend on the number of patients enrolled in the CCM program and your ability to reach specific thresholds. Reimbursement amounts by Medicare can become quite lucrative, with providers earning upwards of $100,000 in additional revenue. One caveat for consideration: a lot of administrative time needs to go into preparing the Medicare documentation which is why partnering with a company providing CCM services is highly recommended.
5. Increased Patient Engagement in their Own Care
The essence of value-based care is patients assert greater control over their health and health care. Open and transparent communication between the patient and the CCM provider, consistent patient engagement and proactive monitoring are key drivers of patient empowerment
6. Continuity of Care for Your Patients
CCM provides a baseline for continuing and maintaining quality care for your patients since patients are being cared for in between their office visits with you. Care consistency and patient empowerment are at the core of value-based care and are key in producing optimal health outcomes that are better for the patients, better for the provider, and better for the industry overall. Reliable CCM provided by established companies assures your patients of continuous attention and better outcomes
7. CCM Care is Proactive Care
Value-based care means taking a proactive approach to care management to avoid complications and eliminate problems that may exacerbate a patient’s conditions before they have a chance to appear or cause harm. Addressing gaps in care is the core goal of a CCM program and a preventative measure to keep your chronic care patients healthy and away from the hospital.
8. Actionable Real-time Clinical Intelligence
CCM increases visibility and insight into your patient’s overall health during gaps in care. Some CCM companies offer 24/7 bi-directional telehealth as a tool to capture patient-specific clinical intelligence, enabling physicians to provide better and more timely care.
9. Improved Patient Satisfaction and Loyalty
A patient’s holistic care experience has a direct bearing on loyalty to your practice. When it comes to CCM, patients seeing improvements in their conditions will develop a sense of trust, stability and satisfaction in a service like CCM. This will reflect favorably on your organization. Also, the personalized attention that a CCM program provides will not only result in a better patient-practice relationship, and it will also help improve patient loyalty and happiness
10. Availability of Companies Providing CCM Services
There are a number of companies like PharmD Live who you can partner with to establish an effective and efficient CCM program. Each of them has a different business model on how they administer chronic care, so you may want to research your options before selecting the ideal partner for you. For example, PharmD Live is the only company providing CCM solutions through its network of board-certified clinical pharmacists because they are among the best suited for this role thanks to their clinical preparedness in disease management and their unique expertise as medication experts. Medications are the first line of therapy for most chronic care patients, and when not used as prescribed, adverse drug events are common. Having a clinical pharmacist to help manage and monitor a patient’s medications makes the patient feel safer and it will make you feel more at ease knowing your patient is in the care of a clinical professional.
PharmD Live is a company offering premium chronic care management services to all types of healthcare organizations. Our focus is on delivering an optimal chronic care experience for your patients and providing a greater level of efficiency, cost savings, and additional revenue for your organization.
(Source: Hidden Hazards, A Survey of Primary Care Physicians and Medicare Patients, 2018)
(Source: Wu, Shin-Yi and Green, Anthony. Projection of Chronic Illness Prevalence and Cost Inflation. RAND Corporation, October 2000).