Care Management Explained: Services & Significance for Your Medical Practice

Nurse offering care management to man

Care management unites a patient with their physicians, caregivers, and family to coordinate and administer high-quality care at lower costs. As the healthcare landscape continues to reward value-based care, care management programs are also seen as a key investment by medical practices. 

The Centers for Medicare & Medicaid Services (CMS) reimburse providers for certain services provided by care management programs. Care management programs also earn additional revenue for your practice and improve patient experiences.

Individualized care is essential to producing positive clinical outcomes, especially for patients managing chronic conditions. Chronic Care Management (CCM) is a care management program tailored to address the complexities presented by chronic conditions

Patients with multiple chronic conditions are often at risk of insufficient care, poor care coordination, and high healthcare costs. Using the care management model, CCM services join physicians and patients with a dedicated care team to facilitate an optimal wellness journey.

In this article, we will explore how the care management model can help your practice deliver high-quality care and promote positive clinical outcomes for your patients. We’ll also address what to look for when selecting a care management service for your practice and share how ChartSpan can elevate your practice’s care management with a full-service CCM program.

What is care management?

Care management is a cooperative, patient-centric healthcare strategy designed to assist patients and their support systems in coordinating and managing care. Care management aims to improve the quality and cost of care provided to those managing multiple chronic or complex conditions by individualizing healthcare. 

The care management model strives to reduce hospitalizations, encourage patient engagement, and optimize care coordination and resource utilization. Care management also encompasses the behavioral, social, and psychological factors that contribute to a patient’s overall health. 

Care management strongly emphasizes preventative care, closing care gaps, and patient engagement and self-management. Comprehensive care management also requires collaboration and lifestyle integration. 

Under the care management model, individualized care plans are created based on the needs of the patient. For patients to achieve optimal health outcomes, their care management plans must integrate into their lives and be supported by their caregivers and communities. 

Care plans that only focus on treating the conditions and diseases in isolation ignore factors that can greatly influence a patient’s health. When care providers pivot to a holistic, patient-centric approach to care, they can implement care plans that improve the patients’ conditions while reducing hospitalizations, redundant testing, and unnecessary expenditures.

What is a care management program?

A care management program is a set of services that deliver high-quality care to patients with conditions and complex medical needs. A care management program includes care planning, preventative health education, high-touch patient communication, care coordination, and personalized wellness plans. Care management programs also benefit providers by improving quality scores and providing support to your staff. 

Fully-managed care management programs relieve your practice of the overwhelming workload that accompanies the implementation of care management models. For example, ChartSpan’s Chronic Care Management program complements your staff with care teams to identify and enroll eligible patients in CCM. Our care team then continues to engage and assist patients every month, facilitate care, document all patient information, and share patient information with you through your practice’s EMR.

What are the benefits of care management?

Care management programs empower patients by actively involving them in their own care journey. Through education and engagement, patients learn how to manage their conditions, mitigate risk factors, and advocate for their needs. 

Reimbursable care management programs can also increase recurring revenue for practices. Policymakers like Medicare have introduced billing codes for programs, like CCM, that reimburse practices for managing and coordinating the care of chronically ill patients.

Care management has several key benefits for your practice: 

  • Lowers treatment costs
  • Improves care coordination
  • Reduces patient hospitalizations
  • Eliminates duplicated testing
  • Promotes positive clinical outcomes for patients
  • Empowers and engages patients in their care journey
  • Increases recurring revenue for practices

Learn more: How Chronic Care Management earns recurring revenue for your practice

What are examples of care management?

The Center for Medicare & Medicaid Services (CMS) identifies four categories of care management: 

  • Chronic Care Management: Chronic Care Management provides preventative resources and support for patients managing multiple chronic conditions, including care coordination and ongoing communication. 
  • Transitional Care Management: Transitional Care Management focuses on a patient’s smooth transition between healthcare settings, like when a patient is discharged from a hospital and returns home.  
  • Advance Care Planning: Advance Care Planning is the planning and documentation of a patient’s future medical care in the event they become unable to communicate their preferences or make decisions themselves. 
  • Behavioral Health Integration: Behavioral Health Integration combines both the medical and mental health of a patient into their primary care, aiming to remove barriers to mental healthcare imposed by cost, waiting lists, and scarcity of mental health resources.  

However, care management can also include services like pain management, resource utilization management, and palliative care. Care management is a patient-centric approach to healthcare, so the needs of each patient will dictate their individual care plan.

How ChartSpan’s CCM program helps your practice improve care management 

ChartSpan, the largest fully-managed Chronic Care Management company, provides your practice with a dedicated care team to handle patient eligibility and enrollment, ongoing education, and personalized care plans for qualifying patients. ChartSpan can help your practice achieve the high-quality, low-cost goals established by the care management model through monthly communication with patients about their wellness journey. 

Our CCM program encourages patient adherence to wellness plans, identifies gaps in care, and assists in overcoming obstacles presented by social or financial conditions. Our care team can arrange transportation to clinical appointments, facilitate medication delivery, connect patients to local food banks, and help patients enroll in community activities to combat loneliness and isolation.  

Every month, each enrolled patient receives a call from a care team coordinator to discuss their individualized care plan. This extensive communication is rigorously documented and provided to your practice. 

The ChartSpan care team also coordinates with your patients’ other providers to ensure their medical records are accurate and up-to-date. Additionally, all enrolled patients have 24/7 access to a nurse care line. The nurse team can aid them with health-related questions and triage any urgent or emergent needs appropriately. 

Our CCM program streamlines care coordination and fosters patient engagement and self-management. As a result, the quality of care the patient receives improves, patient satisfaction increases, and hospitalizations are reduced by an average of 20%

A care management program like ChartSpan’s helps patients and practices struggling with the complexities presented by coexisting chronic conditions while generating an additional stream of revenue for your organization. By offering CCM to your eligible patients, you can bill Medicare and other insurance providers for the time spent managing and coordinating care. 

Learn more: Effectivity of Chronic Care Management Programs.

What to look for in a care management program

A care management program improves quality of care through patient marketing and enrollment, ongoing education and outreach, community resource engagement, and care coordination.

1. Patient marketing and patient enrollment 

Effective patient marketing is paramount to the success of care management implementation. Many care management programs, like CCM, may require the patient to pay a monthly copay. While a practice’s healthcare professionals are thoroughly trained in their medical or patient care fields, introducing a new program may not be something they’re comfortable with. 

ChartSpan’s CCM program provides patients with ample marketing materials before any conversation about enrollment in the program. ChartSpan’s marketing campaigns articulate the value of the program to the patient, explain the details of copay obligations, and educate patients on what to expect after enrollment. Most practices do not have the resources or experience necessary to launch their own effective marketing campaigns. 

Chartspan’s CCM program also has a team of Enrollment Specialists who can reiterate the benefits of enrollment and obtain patient consent for the care management program. 

ChartSpan averages 55% enrollment of eligible Medicare patients. Practices that try to implement CCM independently see an average of 10% enrollment. By utilizing a team of specialists to handle patient enrollment, you can achieve high conversion rates and reduce the workload for your practice. 

Learn more: How to maximize patient enrollment in your CCM program

2. Outreach, education, and communication

Consistent communication is key to the success of a care management plan. Our Chronic Care Management service provides every enrolled patient with a monthly care coordination call. When a care team is in regular dialogue with a patient, they can educate the patient about their conditions, treatment options, and medications.

This proactive communication also allows for early intervention. Care team members can identify new or worsening symptoms as they emerge. Timely clinical interventions are critical for preventing the exacerbation of chronic conditions. Early interventions can also significantly reduce a patient’s healthcare costs by preventing the progression of the disease before it becomes more complex and expensive to treat.  

Frequent conversations around a patient’s wellness plan also keep the patient engaged in self-management of their conditions. This high-touch model of patient communication extends care management beyond the walls of your practice and integrates it into your patients’ lives. 

When a care team makes monthly calls to check in with a patient, they can identify and address gaps in care, like missing vaccinations or cancer screenings. The care coordinator can then assist the patient by answering any concerns they have about upcoming screenings and helping them schedule the necessary appointments. 

The care team members can also discuss any physical, mental, and social difficulties the patient may be experiencing. This insight allows care teams to provide resources and education to the patient, helping them overcome these obstacles and adhere to their care plan.   

ChartSpan’s CCM services also offer enrolled patients access to a 24/7 nurse care line. The nurse care line can be utilized to answer patient questions at any hour of the day. For example, patients experiencing worrisome symptoms or adverse reactions to a new medication can use the hotline to access professional medical guidance. The nurses can help patients determine the severity of their symptoms and can recommend an appropriate course of action.

3. Community resource utilization 

Social Determinants of Health (SDOH) play a critical role in a patient’s health outcomes. Care management emphasizes a holistic and patient-centric view of healthcare. Connecting patients with community resources can help improve mental health, stimulate healthy lifestyle choices, and remove barriers to healthcare access.  

Elderly patients experiencing loneliness or depression can be enrolled in programs at their local YMCA or Silver Sneakers, for example. This promotes physical activity in addition to fostering social connections for the patient. Patients without adequate transportation can have rides arranged to upcoming doctors’ appointments and their medications delivered. Patients living on fixed incomes can be connected to local resources like food banks to help relieve financial insecurities. Through monthly calls, our care coordinators can identify patients in need of community interventions and help connect them to these resources.

4. Coordination of care

Patients with chronic conditions usually receive care from numerous healthcare organizations, including diagnostic and laboratory services. In the absence of care coordination, this can result in incomplete patient data or duplicated tests. When the patient has a dedicated care coordinator through a CCM program, it is the responsibility of the coordinator to request records from the specialist and include them in the patient’s documentation. The documentation recorded by the CCM care team can then be shared with the provider who recommended the patient for CCM. Well-coordinated care prevents redundancies. 

Learn more: How care coordination creates positive patient outcomes.

Care management software vs. full-service programs

When it comes to care management implementation, there’s no shortage of options available. However, it’s a mistake to assume that you can easily implement a successful care management program through third-party software alone. If your practice has no experience running a care management program and doesn’t have enough people to handle the extra workload, you might not succeed at care management. 

When practices consider implementing a care management service, they often look at a  Chronic Care Management program first. CCM is labor-intensive and technologically complex and requires rigorous adherence to CMS’s rules. ChartSpan’s fully-managed, turnkey care management program ensures that an experienced, scalable team handles this workload. Full-service CCM programs have an appropriate infrastructure in place, experience with auditing and analytics, and staff trained to maximize enrollment and return on investment for your practice.

Learn more: SaaS vs. Fully Managed Chronic Care Management.

Why choose ChartSpan’s full-service Chronic Care Management program over CCM software?

A full-service Chronic Care Management program offers numerous advantages over CCM software. Our full-service CCM program is staffed by a team of skilled professionals who are dedicated to providing a thriving CCM program for your practice and your patients.  

Labor costs

Care management software services require your practice to market and enroll patients into the service, manage patient churn, and organize and execute patient communication. Our turnkey care management program already has a staff of trained, experienced care coordinators, nurses, and Enrollment Specialists ready to own these responsibilities.

Infrastructure & scalability

With a fully-managed CCM program, you can easily enroll and service more and more eligible patients through the program. ChartSpan will take responsibility for scaling the labor, infrastructure, analytics, and quality assurance the program requires.

CMS compliance

CMS has strict rules for programs like CCM. These programs require monthly audits, encrypted, HIPAA-compliant integrations with EHRs, and detailed documentation. A CCM software alone cannot manage all of these variables, which require extensive internal research to remain CMS-compliant. Fully-managed CCM programs eliminate this added pressure by handling all compliance rules, without interrupting or complicating your pre-existing workflow.

Software implementation

Additional software requires additional training for your clinicians. This is yet another new software and login for your staff to learn, and the complexity may deter company buy-in. 

Human connection

Many software solutions rely on automation, like texting or AI-generated communication. With a full-service CCM program, your patients are contacted by compassionate professionals. The element of human connection helps establish patient trust and encourages patients in the ongoing management of their conditions. 

Learn more: The benefits of a CCM service provider vs. a CCM software.

Enhance care management with ChartSpan

If you decide to pursue a care management program like Chronic Care Management, ChartSpan’s CCM program will provide your practice with improved clinical outcomes, stronger patient connections, and recurring revenue. Our team will help your patients achieve their healthcare goals and assist your practice in enrolling patients, managing churn, billing CCM services, and scaling your CCM program. 

Contact us to learn more about the transformative implications a CCM program can have for providers and patients alike. 

You may also like: 

Jon-Michial Carter is the Co-founder and Chief Growth Officer of the largest managed Chronic Care Management (CCM) company in the United States,...

Published: July 31, 2023

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