Despite new CPT codes that reimburse physician practices for select chronic care management (CCM) services, almost half of healthcare organizations lack a formal CCM program, leaving critical reimbursement dollars on the table, according to 125 respondents to the Healthcare Intelligence Network’s (HIN) 2015 Chronic Care Management survey, conducted in January 2015.
However, 92 percent of respondents believe the Medicare CCM reimbursement codes that became effective January 1, 2015 will prompt equivalent quality overtures from private payors, underscoring care coordination’s importance in a value-based healthcare system.
We also asked respondents how they structured their CCM programs, and who had primary responsibility for CCM services. Following are their responses.
- Almost 45 percent of respondents to HIN’s 2015 CCM survey have yet to launch a CCM initiative, the survey determined.
- A diagnosis of diabetes is the leading criterion for admission to a CCM initiative, said 89 percent of respondents with existing CCM programs.
- A primary care physician or healthcare case manager most often bears primary responsibility for CCM, say 29 percent of survey respondents.
- Just over one-third of respondents — 35 percent — are currently reimbursed for CCM-related activities.
- Patient engagement is the most difficult challenge of CCM, according to one-third of survey respondents.
- The majority of CCM tasks are conducted telephonically, say 88 percent of respondents.
- Almost three-quarters of respondents — 72 percent — admit patients with hypertension to CCM programs, respondents said.
- Healthcare claims are the most frequently mined source of risk-stratification data for CCM, say 72 percent of respondents.
- More than half of respondents — 51 percent — include palliative care or management of advanced illness in CCM programs.
- On average, each CCM patient is seen monthly, say 29 percent of respondents.
2015 Healthcare Benchmarks: Chronic Care Management captures tools, practices and lessons learned by the healthcare industry related to the management of chronic disease. This 40-page report, based on responses from 119 healthcare companies to HIN's industry survey on chronic care management, assembles a wealth of metrics on eligibility requirements, reimbursement trends, promising protocols, challenges and ROI.