Posts Tagged ‘chronic care’

Infographic: How Do We Fight Chronic Diseases?

December 16th, 2015 by Melanie Matthews

Chronic disease is the leading cause of death in the United States and accounts for a majority of our healthcare spending, according to a new infographic by eVisit.

The infographic looks at how to manage care for chronic care patients, including the use of telehealth.

Real-time remote management of high-risk populations curbed hospitalizations, hospital readmissions and ER visits for more than 80 percent of respondents and boosted self-management levels for nearly all remotely monitored patients, according to 2014 market data from the Healthcare Intelligence Network (HIN).

Remote Monitoring of High-Risk Patients: Telehealth Protocols for Chronic Care Management profiles a successful eight-year initiative by New York City Health and Hospitals Corporation’s (NYCHHC) House Calls Telehealth Program that significantly lowered patients’ A1C blood glucose levels.

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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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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: 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.

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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.

12 Things to Know About Chronic Care Management

February 24th, 2015 by Cheryl Miller

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.

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.

Guest Post: 10 Medication Adherence Facts to Know in 2015

January 22nd, 2015 by Troy Hilsenroth

medication adherence

$105 billion of avoidable U.S. healthcare costs is due to medication non-adherence.

With 50 percent of Americans suffering from at least one chronic condition in their lifetime, medication management affects nearly everyone at some point. Whether an individual takes multiple medications or cares for a family member who is, the importance of taking medications as prescribed is highly undervalued. While missing a pill one day may seem insignificant, the effects of these habits can be highly detrimental and far-reaching, as guest blogger Troy Hilsenroth explains.

Not taking medication as prescribed, or medication non-adherence, can result in costly hospital bills, declines in patient wellness, and medical complications among other outcomes. Due to these very real risks, additional awareness about this serious public health issue is crucial moving into 2015.

Pharmacists already possess the patient care tools necessary to help with this problem. Patients need to access available tools to improve their medication adherence and educate themselves about their meds. The first step in reversing these trends is to promote education around the severity of medication non-adherence.

The following are ten medication adherence statistics to know in 2015:

  • In the United States, avoidable healthcare costs add up to $213 billion, of which $105 billion is due to medication non-adherence, according to the Express Scripts 2013 Drug Trend Report.
  • Non-adherence causes 30-50 percent of treatment failures and 125,000 deaths annually. 1
  • 64 percent of readmissions within 30 days are due to medication issues, according to HIN’s 2010 Benchmarks in Improving Medication Adherence.
  • Medications are not continued as prescribed in about 50 percent of cases, according to a 2013 Centers for Disease Control and Prevention (CDC) presentation.
  • Nearly 50 percent of Americans have one or more chronic conditions that require prescription medications, according to the CDC.
  • Medication adherence is higher among patients who see the same healthcare provider each time they have a medical appointment. In this group, the average adherence is 81 percent, according to “Medication Adherence in America: A National Report Card,” a recent report from the National Community Pharmacists Association.
  • Non-adherent patients are 17 percent more likely to be hospitalized than adherent patients, with a cost that exceeds that of an adherent patient by $3,575. 2
  • Generic medications have higher rates of adherence than name brand prescriptions, with 77 percent of patients adhering to generics as opposed to 71 percent with the name brand. 3
  • For some classes of medication, up to 30 percent of prescriptions are never filled by the patient, according to the Network for Excellence in Health Innovation (NEHI).
  • Patients receive 3.4 more refills per prescription in a 12-month period when their refills are synchronized, according to the National Community Pharmacists Association.

Medication non-adherence poses a very real risk for patients and their providers. A collaborative care team including physicians, pharmacists, and the patient is crucial to continuing education on this issue and establishing a medication management strategy to stay healthy and out of the hospital.

About the Author: Troy Hilsenroth has been with Omnicell for over six years, and currently serves as its vice president of the non-acute care division. In this role, he develops and delivers solutions to help organizations develop new and better ways of doing business and cultivates programs that change healthcare dynamics. Throughout his 22-year career in healthcare, his mission has been to deliver higher clinical quality at a lower cost. Prior to working at Omnicell, Troy served as a licensed clinical pharmacist for 14 years in a broad range of pharmacy environments, while also working as a firefighter and paramedic.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.


1. Smith D, Compliance Packaging; a patient education tool, American Pharmacy, Vol. NS29, No 2, February 1989.
2. A. Dragomir et al. (May 2010.). Impact of Adherence to Antihypertensive Agents on Clinical Outcomes and Hospitalization Costs. Medical Care, 48 (418-425). doi: 10.1097/MLR.0b013e3181d567bd
3. O’Riordan, Michael. (2014, September 15). Generics Beat Brand-Name Statins for Patient Adherence and Improving Outcomes. Medscape. Retrieved from http://www.medscape.com/viewarticle/831707

CMS Chronic Care Management Medicare Reimbursement: Sizeable Revenue, Health Outcome Opportunities

November 21st, 2014 by Cheryl Miller

Beginning January 2015, Medicare will pay a flat, monthly chronic care management (CCM) fee to providers coordinating care for beneficiaries with more than one chronic condition. This change will expand the current Medicare payment policy to include non face-to-face management services previously included within payments for evaluation and management (EM) services, amount to about $40 a beneficiary, a sizeable new source of revenue for eligible providers.

The targeted population is also substantial; as recent news story reported by the Healthcare Intelligence Network (HIN), 87 percent of U.S. adults ages 65 and older have at least one chronic illness, and 68 percent have two or more, the highest rates in a new 11-country Commonwealth Fund survey.

But healthcare organizations do not have that much time to prepare for the newly released 2015 Medicare Physician Fee schedule, which finalized the CCM reimbursement. Who can bill for CCM, what constitutes a chronic condition, which patients are eligible to receive CCM services, and the scope of services required were among the issues discussed during Chronic Care Management Medicare Reimbursement: New Revenue Opportunities for Care Coordination, a November 19th webinar, now available for replay. Rick Hindmand, an attorney with McDonald Hopkins, a law firm that advises a nationwide client base extensively on healthcare reimbursement, shared insight on these issues and how to best prepare for this reimbursement opportunity.

Those allowed to bill for CCM reimbursement fall into one of five categories: physicians, advanced practice registered nurses (APRNs), physician assistants (PAs), clinical nurse specialists and certified nurse midwives. If these practitioners are part of a practice entity, that entity can bill for it as well.

Beneficiary requirements are not as clear cut, Mr. Hindman continued. Eligible patients must have at least two chronic conditions that are expected to last at least 12 months or until death, and those conditions need to create a significant risk of death, acute exacerbation/decomposition or functional decline. Specific definitions of conditions can be found at CMS’s Web site.

And because CMS does not want to pay for duplicative services, CCM is not allowed for beneficiaries who receive services for transitional care management, home healthcare supervision, hospice supervision, and various end stage renal disease (ESRD) conditions. Patients attributed under the Multi-payer Advanced Primary Care Practice Demonstration (MAPCP) and the Comprehensive Primary Care (CPC) Initiative are also excluded.

Once these requirements are satisfied, providers must offer and document 20 minutes of CCM services a month, which enhance access and continuity of care, care management, transition management, and coordination, Mr. Hindman continues.

The CCM fee comes to about $40 a beneficiary, a significant revenue source once applied to all patients within a practice. Why the change now? Mr. Hindman speculates that CMS is finally realizing that care management is a crucial component of primary care. But questions and details await future guidance from CMS, and satisfying and documenting compliance with the CCM reimbursement requirements is going to present a challenge for many practices.

But the time and effort is worth it, he says. “With careful structuring, chronic care management can provide the potential to improve the health of their patients, while also providing some significant financial benefits for the practice.”

To listen to an interview with Mr. Hindman, click here.

Infographic: Getting Paid for the New Chronic Care Management Code

November 21st, 2014 by Melanie Matthews

Under CMS’ new Chronic Care Management (CCM) program, which takes effect in 2015, physician practices can receive reimbursement for non-encounter based follow up care to coordinate care for those with chronic conditions.

A new infographic by HealthFusion provides details on the physician practice and patient responsibilities for practices to be eligible for this reimbursement.

Chronic Care Management Medicare Reimbursement: New Revenue Opportunities for Care CoordinationStarting January 2015, physician practices will be eligible to receive reimbursement for chronic care management services provided by physicians, advanced practice nurses, physician assistants, clinical nurse specialists and certified midwives to Medicare beneficiaries with multiple chronic conditions. The 2015 Medicare Physician Fee schedule, which finalized the Chronic Care Management reimbursement, was just released, leaving healthcare organizations with little time to prepare for the final aspects of this new reimbursement opportunity.

During Chronic Care Management Medicare Reimbursement: New Revenue Opportunities for Care Coordination a November 19th webinar, now available for replay, Rick Hindmand, attorney with McDonald Hopkins, will share critical insight into how physician practices can best structure their practice to receive this additional reimbursement. The McDonald Hopkins law firm advises a nation-wide client base extensively on healthcare reimbursement.

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Infographic: How Case Managers Help Patients Navigate the Healthcare Maze

October 8th, 2013 by Jackie Lyons

Case managers can help patients understand their health status, care and treatment options and the importance of such treatments.

Furthermore, 44 percent of board-certified case managers say helping patients navigate the healthcare system is an important role. This infographic also provides a look at the healthcare experience with and without a case manager, including how chronic disease care and preventable readmissions are affected.

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You may also be interested in this related resource: 2013 Healthcare Benchmarks: Case Management.