Posts Tagged ‘Chronic Care Management’

Infographic: Chronic Care Management Reimbursement Trends

October 23rd, 2015 by Melanie Matthews

Chronic Care Management Reimbursement TrendsPhysician participation in the chronic care management program is expected to grow to 70 percent of all practices by the third quarter of 2016, according to a new infographic by Smartlink Mobile.

The infographic looks at the program’s impact on physician practices and practices’ understanding of the program requirements.

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 for physician practices to maximize CCM reimbursement.

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Infographic: How the Affordable Care Act Is Changing Medicare

June 19th, 2015 by Melanie Matthews

One of the Affordable Care Act’s lesser known goals is to improve Medicare’s coverage, care and financial outlook, according to a new infographic by the Commonwealth Fund.

The infographic drills down on the impact that the ACA has had on reducing gaps in care, improving chronic care management, emphasizing high-value care and slowing healthcare spending.

11 Profitable Value-Based Reimbursement Models: Lessons from Early AdoptersCMS’s ambitious agenda for moving Medicare into alternative payment models is driving the U.S. healthcare system toward greater value-based purchasing at a furious rate. Private payors also have pledged to continue to shift payments away from fee for service and into alternative payment models such as accountable care organizations (ACOs). Fortunately, many healthcare organizations are already exploring value-based payments—often a single innovation at a time—testing models that reward providers for meeting Triple Aim goals of improving patient experience and population health while reducing healthcare’s per capita cost.

11 Profitable Value-Based Reimbursement Models: Lessons from Early Adopters encapsulates nearly a dozen such approaches, from Bon Secours’ building of a business case for its multidisciplinary care team to the John C. Lincoln ACO’s deep dive into data analytics to identify and manage the care of high-risk, high-cost ‘VIP’ patients to ‘beat the benchmark’ to WellPoint’s engagement of specialists in care coordination.

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Infographic: Building a High-Acuity Patient Care Model

June 8th, 2015 by Melanie Matthews

At the core of high-acuity patient care model is a multidisciplinary clinical care team supporting the patient with a mix of in-office and in-home care, according to a new infographic by Oliver Wyman.

The infographic illustrates the links in a high-acuity patient care model that together can more fully address the needs of the elderly Medicare Advantage (MA) population and the chronically ill.

Physician Reimbursement for Chronic Care Management: Identifying New Practice Revenue OpportunitiesStarting 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.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

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

10 Tools to Complement Chronic Care Management

April 23rd, 2015 by Cheryl Miller

Despite new CMS payments to physician practices for select chronic care management (CCM) services, almost half of healthcare organizations lack a formal chronic care management program, leaving critical reimbursement dollars on the table, according to new market metrics from the Healthcare Intelligence Network (HIN). Almost 45 percent of 119 respondents to HIN’s 2015 Chronic Care Management survey, conducted in January 2015, have yet to launch a CCM initiative, the survey determined. However, 92 percent of respondents believe the Medicare CCM reimbursement codes that became effective January 1, 2015 will prompt comparable quality overtures from private payors, underscoring care coordination’s importance in a value-based healthcare system.

How to best capitalize on these reimbursement opportunities? Follow-up with patients immediately following hospital discharge is the most common component of CCM initiatives, according to 81 percent of respondents. Following are nine more tools to complement chronic care management, in respondents’ own words:

  • Holding care manager, primary care provider (PCP) and clinical team reviews;
  • Any patient over a certain risk score gets a phone call from the physician or advanced practitioner registered nurse (APRN) for a follow up with the patient.
  • Utilizing a structured assessment tool in the electronic health record (EHR);
  • Coaching the patient to wellness and holding them accountable;
  • Addressing psychosocial issues with care coordination strategies;
  • Having a life planning agenda; knowing what to do if symptoms worsen, and what end-of-life agreements are in place;
  • Conducting motivational interviewing to support lifestyle changes;
  • Coordinating with nurse practitioners; and
  • Using remote monitoring devices for heart failure patients.

Source: 2015 Healthcare Benchmarks: Chronic Care Management

Chronic Care

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.

5 Trends in Chronic Care Management by Physician Practices

March 17th, 2015 by Cheryl Miller

One hundred percent of physician practices rely on face-to-face and telephonic visits to administer chronic care management (CCM) services, according to respondents to the Healthcare Intelligence Network’s 10 Questions On Chronic Care Management survey administered in January 2015.

A total of 119 healthcare organizations described tactics employed, 17 percent of which were identified as physician practices. A sampling of this sector’s results follows.

  • Less than half of physician practices (46 percent) admitted to having a chronic care management program in place. But they overwhelmingly agree (100 percent) that CMS’s CCM initiative will drive similar reimbursement initiatives by private payors.
  • This sector’s criteria for admission to existing chronic care management programs is on par with other sectors except for asthma; just 17 percent of physician practices use this as an admitting factor versus 49 percent of all respondents.
  • Not surprisingly, this sector assigns major responsibility for CCM to the primary care physician, versus 29 of all respondents. This sector also relies on healthcare case managers (40 percent versus 29 of all respondents) and advanced practice nurses (APNs) (20 percent versus 8 percent overall) to assist with CCM.
  • This sector relies most heavily on face-to-face visits for CCM services (100 percent versus 71 percent for all respondents) and telephonically (100 percent versus 87 percent of all respondents).
  • Among the biggest challenges for this sector is reimbursement (33 percent versus 20 percent overall) and documentation (17 percent versus 2 percent overall). Unlike other sectors, patient engagement is not a major challenge (17 percent versus 33 percent overall).

Source: 2015 Healthcare Benchmarks: Chronic Care Management

http://hin.3dcartstores.com/2015-Healthcare-Benchmarks-Chronic-Care-Management_p_5003.html

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.

10 Healthcare Trends Measured in 2014: Medical Neighborhoods, Data Analytics Flourish

January 13th, 2015 by Patricia Donovan

2014's HINtelligence Reports captured trends in healthcare delivery, technology and utilization management.


Each year, the Healthcare Intelligence Network’s series of HINtelligence Reports pinpoint trends shaping the industry, from cutting-edge care collaborations to remote patient management connections to tactics to reduce avoidable utilization.

HINtelligence Report benchmarks are derived from data provided by more than one thousand healthcare companies.

Here are 10 highlights from 2014 HINtelligence Reports that support Triple Aim goals of improving population health and the patient experience while reducing the per capita cost of healthcare.

Share your reactions with us on Twitter @H_I_N.

  • Readmissions: More than half of survey respondents participate in post-acute partnerships, with home health collaborations the most common (79 percent). These partnerships serve to streamline processes and care transitions, educate and align staff, and implement changes of value to patients, said respondents to the fourth annual Reducing Hospital Readmissions Survey.
  • Palliative Care: While the majority of respondents (68 percent) administer palliative care on an inpatient basis, more than half (54 percent) say care is conducted on home visits and just under a third offer palliative care at extended care facilities.
  • Patient-Centered Medical Home: Prepared to take their medical homes to the next level of care in the year to come, almost half—48 percent—have joined or expect to join a medical home neighborhood, defined by TransformMed℠ as “a strong foundation of transformed primary care practices aligned with health systems and specialists to insure that care is maximally coordinated and managed.
  • Remote Patient Monitoring: More than half of 2014 respondents—54 percent—have instituted remote monitoring programs, the survey found, which was most often employed for patients or health plan members with multiple chronic conditions (83 percent). Other targets of a remote monitoring strategy included frequent utilizers of hospitals and ERs (62 percent) and the recently discharged (52 percent).
  • Telephonic Case Management: More than 84 percent of respondents utilize telephonic case managers. „One-fifth of telephonic case managers work within the office of a primary care practice.
  • Population Health Management: The last two years reflects a dramatic surge in the use of data analytics tools barely on population health management’s radar in 2012: the use of health risk assessments (HRAs), registries and biometric screenings more than tripled in the last 24 months, while electronic health record (EHR) applications for population health increased five-fold for the same period.
  • Emergency Room Utilization: Among populations generating the majority of avoidable ED visits, dual eligibles jumped nearly 10 percent in the last four years, from 2 to 11 percent, while other populations—high utilizers, Medicare and Medicaid—remained roughly the same. „„Chronic disease replaced pain management as the most frequently presented problem in the ER, at 54 percent.
  • Stratification of High-Risk, High-Cost Patients: The „LACE readmission risk tool (Length of stay, Acute admission, Charleston Comorbidity score, ED visits) is considered the primary indice and screen to assess health risk, according to 33 percent of respondents.
  • Embedded Case Management: Fifty-seven percent of respondents embed or co-locate case managers in primary care practices, where their chief duties are care and transition management, reducing hospital readmissions and patient education and coaching.
  • 2015 Healthcare Forecast: Almost 92 percent of 2015 respondents said the impact of value-based healthcare on their business has been positive, with more than one quarter identifying healthcare’s value-based shift as the trend most likely to impact them in the year to come.

Make your healthcare voice count in 2015 by answering 10 Questions on Chronic Care Management by January 31, 2015. You’ll receive a complimentary HINtelligence Report summarizing survey results.

Ideas to Engage Providers and Patients in CMS 5-Star Quality Rating Improvement

September 17th, 2013 by Jessica Fornarotto

With an additional star in CMS’s Five-Star Quality Ratings System worth about $50 per member per month (PMPM),* health plans are anxious to polish their Medicare Advantage ratings. One area ripe for improvement is the management of chronic conditions, notes Joseph Johnson, vice president of L.E.K. Consulting — an area where both providers and patients can be recruited to help.

During a recent webinar on A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings, suggested strategies for health plans to engage providers and patients in the management of chronic conditions.

Question: One area where health plans are struggling in is managing chronic conditions. What can health plans do to improve in this area?

Response: From a managing chronic conditions standpoint, operate under the guiding principle that these are in fact measures that are highly driven by the engagement of the provider network that a health plan utilizes. You also want to make sure that providers actually have aligned incentives, like creating profit-sharing goals for example, to the extent that a specific target for a given CMS Star Quality Rating measure within managing chronic conditions is met or exceeded, and then sharing part of the incremental revenue uplift with the providers that are part of that focused targeted improvement.

Also, provider report cards are another good tactic that we’ve seen health plans employ in order to help drive improved Star Ratings. Those are a couple of tactics that we’ve seen used in practices that did yield material results.

Question: Are there any success stories from plans utilizing house call programs to manage chronic conditions?

Response: We’ve seen a positive incremental yield on house call programs. Those programs can serve a dual purpose both with incremental revenue Star uplift, as well as an incremental improvement in coding initiatives and hierarchical condition categories (HCC) and Risk Adjustment Factor Type (RAFT) scores. To the extent that you know the algorithm is being used to target those house call programs are implemented effectively.

Question: Does the senior population participate in digital patient engagement programs?

Response: Yes, although many say that the senior population is not accustomed to digital communication channels. Increasingly, we’ve seen the senior population become more and more wired, so to speak. There are benefits for this type of communication channel; it can be an effective, low-cost way of engaging in some member outreach that can be effective, particularly when targeted at raising overall CMS Five-Star Quality scores.

Question: Can member engagement programs increase CMS Five-Star Quality Ratings?

Response: Certainly member engagement programs, when appropriately targeted and directed, can result in meaningful uplifts and improvements in Star Ratings. With the health plans that we’ve worked with, targeting mailings, telephonic outreach or other forms of outreach — with low performing member/provider cohorts — have been a great way of increasing overall performance in a way that does materially change and improve overall Star Ratings, to the extent that they are targeted efforts, as opposed to more far reaching or broad, blanket efforts across the entire member base. And the ROI and the yield are certainly higher.

*When moving from a three- to four-star Medicare Advantage plan, according to L.E.K. Consulting.