Posts Tagged ‘Chronic Care Management’

Guest Post: Cracking the Care Management Code: How Providers Can Get Paid for Remote Services

February 21st, 2019 by Melanie Matthews

With a successful remote care management model in place, healthcare organizations can increase annual revenues by about $500 per patient.

Healthcare organizations and physician practices are stepping up efforts to reduce avoidable healthcare utilization and ensure patients receive care in lower-cost settings when appropriate.

As part of these efforts, many providers are considering remote care services, such as e-visits, remote health monitoring, secure messaging, and regular check-in calls with patients. These remote interactions can increase patient adherence to treatment plans and lead to faster interventions when problems arise.

While payers have been slow to reimburse for remote care services (despite the clinical benefits), providers today can take advantage of Centers for Medicare and Medicaid Services reimbursement for Chronic Care Management (CCM) services to improve care management for many of their Medicare patients.

To qualify for CCM reimbursement, practitioners must spend at least 20 minutes of non-face-to-face clinical staff time per month on care coordination for CCM patients. To be included in a CCM program, patients must have two or more chronic conditions expected to last at least one year or until death, and those conditions must place patients at significant risk of death, acute exacerbation, or functional decline.

Payments for CCM services, which can be provided by physicians, physician assistants, nurse practitioners, nurse midwives and their clinical staffs, can range from approximately $43 to $141, depending on how complex a patient’s needs are, according to CMS.

When a successful remote care management model is put in place, healthcare organizations can increase annual revenues by about $500 per patient, which translates to $50,000 per year for an organization with 1,000 CCM patients.

Getting Involved

Recent data show that many providers have yet to take advantage of CCM. In fact, as of 2016, the program had touched only 684,000 Medicare patients, according to a 2017 CCM report. That’s less than 2 percent of all Medicare recipients.

One reason is that providers face many barriers when attempting to implement remote care programs. Technology, of course, is one hurdle, but CCM services also take clinical and administrative staff time and resources (such as time spent billing for CCM services and ensuring compliance).

This is why many organizations are turning to outside partners that specialize in remote care management to deliver CCM. These partners can enroll patients into the CCM program (a step that is much harder than most practices anticipate), deliver remote services each month, ensure compliance, and bill for services.

The Wright Center, a safety-net primary care provider in northeastern Pennsylvania, is one provider that sought outside help to achieve its CCM goals. The result of its partnership with a remote services provider included net new revenue within 14 days of partnering with the company, an additional $536 per enrolled patient per year, a 73 percent patient retention rate after two years, lower hospital admission rates, and higher patient satisfaction scores.

Four Key Attributes

Because many providers have found delivering remote services challenging, it’s important to select a partner that has the right model and proven success improving patient engagement and outcomes. Key capabilities to look for in a partner include:

  1. Being staffed with nurses or other clinicians who become a trusted and integral part of the healthcare organization’s team. These clinical staff members should have a strong record of establishing productive relationships with providers in the healthcare organization and with patients remotely.
  2. Working seamlessly with the EHR and population health tools already in place at the healthcare organization. The partnership should not result in an additional burden on IT staff members at the healthcare organization.
  3. Providing a customized program to suit the healthcare organization’s specific needs, goals, and workflows. An organization’s CCM needs will vary depending on the patient population, in-house resources, and technology already in place. The partner should be able to tailor its services accordingly.
  4. Proactively addressing social determinants of health and barriers to care. For example, it should be able to share results that showcase its ability to engage a senior population and address their unique needs.

As value-based reimbursement gains traction, healthcare organizations that don’t start exploring remote healthcare services will fall behind. It’s time to get involved, and CCM is a great way to start.

Drew Kearney

Drew Kearney

About the Author: Drew Kearney has been a healthcare leader since 2010, with expertise in post-ACA market opportunities and experience leading expansion initiatives in multiple markets. In 2015, he co-founded Signallamp Health, a company that offers a unique solution operationalizing population health.

Infographic: Manage Chronic Disease with the EFST Model for Cultural Competence

November 19th, 2018 by Melanie Matthews

The challenges of serious illness are compounded when there are cross-cultural issues at play, according to a new infographic by Quality Interactions.

The infographic examines the essential questions to ask patients to foster culturally-sensitive healthcare that improves patient adherence and health outcomes.

In the sphere of value-based healthcare, chronic care management (CCM) is a critical component of primary care and population health management. Targeting the Triple Aim goals of better health and care for individuals while reducing spending, CCM is viewed as a stepping-stone to success under Medicare’s Quality Payment Program that launched January 1, 2017.

2017 Healthcare Benchmarks: Chronic Care captures tools, practices and lessons learned by the healthcare industry related to the management of chronic disease.

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Infographic: Chronic Care Management Results

March 26th, 2018 by Melanie Matthews

The Chronic Care Management program through the Centers for Medicare and Medicaid Services (CMS) has produced significant positive changes during its first two years, according to a recent report by CMS researchers, Evaluation of the Diffusion and Impact of Chronic Care Management (CCM) Services: Final Report.

A new infographic by CareSync highlights the results of the CMS report, including benefits to healthcare providers, payers, and patients.

In the sphere of value-based healthcare, chronic care management (CCM) is a critical component of primary care and population health management. Targeting the Triple Aim goals of better health and care for individuals while reducing spending, CCM is viewed as a stepping-stone to success under Medicare’s Quality Payment Program that launched January 1, 2017.

2017 Healthcare Benchmarks: Chronic Care captures tools, practices and lessons learned by the healthcare industry related to the management of chronic disease.

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Have an infographic you’d like featured on our site? Click here for submission guidelines.

8 Findings from CMS Medicare Chronic Care Management Assessment

January 26th, 2018 by Patricia Donovan

YNHHS embedded care coordination

Medicare Chronic Care Management services reduced healthcare utilization and likelihood of hospital admissions for CCM recipients, according to a new CMS report.

Beneficiaries who received Chronic Care Management (CCM) services experienced a lower growth rate in healthcare expenditures compared to those who did not receive CCM services, according to a new evaluation report from the Centers for Medicare and Medicaid Services (CMS).

The lower rate of growth in total Medicare per beneficiary per month (PBPM) expenditures ranged from $28 to $74, after removing the average monthly CCM fee of $29.

The Medicare and Medicaid payor released the report on the diffusion and impact of CCM payment during the program’s first two years of implementation.

In January 2015, CMS introduced a separately billable non-face-to-face Chronic Care Management service (CPT code 99490). The goal of CCM is to improve Medicare beneficiaries’ access to chronic care management in primary care.

Here are seven more findings from the evaluation report:

  • Over 684,000 beneficiaries received CCM services from January 2015 to December 2016, the first two years of the new payment policy.
  • The decreased rate of growth was driven by decreases in expenditures for inpatient hospital services, skilled nursing facility services, and outpatient services; the decreased expenditures were partially offset by increased expenditures of home health and professional services. Researchers similarly found a lower rate of growth among CCM beneficiaries in hospitalizations and all-cause emergency department visits.
  • Receipt of CCM services was also associated with a reduced likelihood of an admission for the ambulatory care sensitive conditions of diabetes, congestive heart failure, urinary tract infection, and pneumonia among CCM beneficiaries, relative to the comparison beneficiaries.
  • A total of 16,549 individual healthcare providers billed for a total of $105.8 million in CCM fees in the first two years of the new payment policy.
  • Chronic Care Management beneficiaries were generally concentrated in the South and had poorer health status than the general Medicare fee-for-service (FFS) population.
  • About 19 percent of beneficiaries only received one month of CCM services; however the majority of beneficiaries received between four and ten months of CCM services, on average.
  • Primary care physicians (PCPs) billed for 68 percent of CCM claims and 42 percent of CCM billers were solo practitioners. Individual providers billed for $105.8 million in CCM fees during the first 24 months of the program and, on average, managed about 47 patients per month. However, the median number of patients was 10, indicating that the average was skewed by a small number of providers delivering CCM services to many beneficiaries. This translates to about $300 in CCM fees per month for providers furnishing CCM services to 10 beneficiaries.

The report did not examine the impact of 2017 CCM policy revisions that significantly increased payment for providing CCM to more medically complex patients.

Read the complete CMS Chronic Care Management evaluation report.

Infographic: Impact of New Hypertension Guidelines

November 27th, 2017 by Melanie Matthews

OM1, an AI health outcomes and data company, has released an analysis on the impact of the new American College of Cardiology (ACC) and American Heart Association (AHA) high blood pressure guidelines. Using the OM1 Intelligent Data Cloud, OM1 performed preliminary analyses to evaluate the impact of the new guidelines on approximately 19 million adults over 20 years of age with more than 120 million blood pressure measurements, who had been seen for a scheduled visit over the last year.

A new infographic by OM1 highlights the findings of this data analysis.

Health Analytics in Accountable Care: Leveraging Data to Transform ACO Performance and Results Between Medicare’s aggressive migration to value-based payment models and MACRA’s 2017 Quality Payment Program rollout, healthcare providers must accept the inevitability of participation in fee-for-quality reimbursement design—as well as cultivating a grounding in health data analytics to enhance success.

As an early adopter of the Medicare Shared Savings Program (MSSP) and the largest sponsor of MSSP accountable care organizations (ACOs), Collaborative Health Systems (CHS) is uniquely positioned to advise providers on the benefits of data analytics and technology, which CHS views as a major driver in its achievements in the MSSP arena. In performance year 2014, nine of CHS’s 24 MSSP ACOs generated savings and received payments of almost $27 million.

Health Analytics in Accountable Care: Leveraging Data to Transform ACO Performance and Results documents the accomplishments of CHS’s 24 ACOs under the MSSP program, the crucial role of data analytics in CHS operations, and the many lessons learned as an early trailblazer in value-based care delivery.

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Infographic: Monitoring and Managing Chronic Disease

November 22nd, 2017 by Melanie Matthews

Patients with chronic conditions rely on their healthcare teams to help them manage their health, according to a new infographic by West Corporation.

The infographic examines the steps providers can take to monitor and manage chronic disease among their patient populations.

In the sphere of value-based healthcare, chronic care management (CCM) is a critical component of primary care and population health management. Targeting the Triple Aim goals of better health and care for individuals while reducing spending, CCM is viewed as a stepping-stone to success under Medicare’s Quality Payment Program that launched January 1, 2017.

2017 Healthcare Benchmarks: Chronic Care captures tools, practices and lessons learned by the healthcare industry related to the management of chronic disease.

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Infographic: 2017 Chronic Care Management Update

December 21st, 2016 by Melanie Matthews

The Centers for Medicare and Medicaid Services has updated the Chronic Care Management (CCM) rules for 2017 to improve adoption of CCM services by reducing the administrative burden on providers, according to a new infographic by CCM Navigator.

The infographic highlights these changes to CCM and new 2017 CCM codes.

2017 Chronic Care Management Update

A 2015 adopter of Medicare’s Chronic Care Management (CCM) reimbursement program, The Center for Primary Care (CPC) quickly expanded its CCM initiative to qualifying Medicare beneficiaries at its nine locations. Today, with a detailed profile of its CCM population and the health improvements and revenue that resulted, the CPC is leveraging this Chronic Care Management experience for participation in MACRA.

Physician Chronic Care Management Reimbursement: Roadmap to MIPS Success Under MACRA describes how early adoption of Medicare’s CCM Reimbursement program enhanced the Center’s MACRA-readiness, laying the foundation for success under the Merit-based Incentive Payment System (MIPS) path.

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Infographic: Are You Ready to Add Recurring Revenue to Your Physician Practice?

July 20th, 2016 by Melanie Matthews

Some 68 percent of the Medicare population have two or more chronic conditions, according to a new infographic by CareSync.

The infographic examines how physician practices can bill for chronic care management (CCM) services under CMS’ CCM program and the impact of CCM on outcomes and the patient experience.

Chronic Care Management Reimbursement Compliance: Physician Requirements for Value-Based RevenueBeyond providing added revenue, billing via Medicare Chronic Care Management (CCM) CPT codes helps to bridge physician practices to value-based care delivery models like the accountable care organization (ACO) or patient-centered medical home (PCMH). Use of the CCM codes is also an opportunity to launch or enhance a chronic care management program. According to 2015 market data, nearly half of responding healthcare organizations lack a formal chronic care management structure, leaving critical reimbursement dollars on the table.

However, practices poised to bill under CCM codes must contend with vague guidance from CMS in certain areas and conflicting interpretations from outside sources on CCM implementation.

Chronic Care Management Reimbursement Compliance: Physician Requirements for Value-Based Revenue sets the record straight on CCM reimbursement compliance, offering strategies for navigating obstacles and meeting requirements.

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Infographic: Chronic Care Management Revenue Opportunities

December 9th, 2015 by Melanie Matthews

The value of gaining experience and proficiency with population management and value-based reimbursement is becoming essential as Medicare shifts a greater portion of its payments to these methodologies. Medicare’s chronic care management reimbursement codes allow practices to get paid while learning about this new shift and gaining confidence and competence with value-based reimbursement, according to a new infographic by McKesson.

The infographic examines the incidence of chronic conditions among Medicare beneficiaries and the revenue opportunity for practices that bill Medicare under the Chronic Care Management codes.

Starting this past January, Medicare is reimbursing physician practices for select Chronic Care Management (CCM) services not previously eligible for reimbursement, underscoring the vital role of care management in primary care.

Physician Reimbursement for Chronic Care Management: Identifying New Practice Revenue Opportunities offers practical guidance to prepare physician practices to maximize CCM reimbursement in the year ahead.

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HINfographic: Chronic Care Management’s Path to Patient-Centered Care Coordination

December 2nd, 2015 by Melanie Matthews

A commitment to chronic care management (CCM) not only offers providers additional revenue via Medicare Chronic Care Management reimbursement but also can be a stepping stone to patient-centered care models like the medical home or accountable care organization (ACO). An inaugural Chronic Care Management survey by the Healthcare Intelligence Network captured current trends in chronic care management.

A new infographic by HIN examines current trends in Medicare chronic care management reimbursement.

2015 Healthcare Benchmarks: Chronic Care ManagementThe desire to improve health outcomes for individuals with serious illness coupled with opportunities to generate additional revenue have prompted healthcare providers to step up chronic care management initiatives. The Centers for Medicare and Medicaid Services now reimburses physician practices for select chronic care management (CCM) services for Medicare beneficiaries, with more private payors likely to follow suit.

2015 Healthcare Benchmarks: Chronic Care Management captures tools, practices and lessons learned by the healthcare industry related to the management of chronic disease. Click here for more information.

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