Top 10 Features of the Best Chronic Care Management Companies
When you are considering implementing a Chronic Care Management (CCM) program for the first time, it can be daunting to know which features, functionality and services are important for an impactful and profitable program. Knowing the top 10 features that lead to a successful program will help you determine which CCM companies are worth partnering with.
What does a successful CCM program look like? You will need to be able to show profitability, improved patient outcomes and patient satisfaction, as well as allocate dedicated clinical, I.T. and enrollment call center labor. In order to be able to track these key metrics, your program will need to be robust with deep analytics, established performance benchmarks and a well-coordinated team of technical, clinical and administrative support personnel. Let’s explore the most important features that should not be overlooked.
Your Chronic Care Management program should have the highest possible security standards in order to protect your patients’ information. All technology and processes related to your program will need to be HIPAA compliant and secure.
At the highest level, you should look for a turnkey program that has achieved HITRUST certifications so that you are confident that all aspects of your program are following the appropriate security measures. Effective HIPAA Compliance and Cybersecurity measures are paramount in protecting patient health information.
Programs with HITRUST certifications will ensure security is continuously monitored to protect against bad actors and their growing exploits to try to access sensitive health information. Successful data breaches affect patients and cause financial and reputational risks to providers.
Similar to other healthcare programs, care management services must adhere to a strict and detailed level of compliance required by the Centers for Medicare and Medicaid Services (CMS). For CCM, this requires that all employees involved in the program should be trained appropriately in the legal intricacies of CCM and rules that must be followed.
There are CMS resources available that can help you understand these various requirements. Major requirements for this program include factors like eligibility, recording patient information and patient consent. While these resources can support you, a CCM partner should be able to identify all the legal necessities of your CCM program so your organization stays compliant.
In addition, regularly scheduled quality auditing processes are required to ensure that all phone calls and documentation follow the guidelines that Medicare has set in place for Chronic Care Management programs. The ability to archive all CCM enrollment and clinical calls for 10 years is one of the most important features of a well-run CCM program, ensuring the ability to pass compliance audits.
The enrollment functionality of your CCM program is one of the most crucial but often underappreciated keys to success. You will need a team of trained professionals to call your eligible beneficiaries with multiple chronic conditions, educate them on the benefits of the program and encourage them to enroll.
While this may seem like a simple need, it's far more complex if you want to maximize your CCM program. These trained professionals need to be informed about chronic conditions and the benefits of a CCM program. In addition, they should have a marketing skillset to encourage enrollment.
Without marketing capabilities, your CCM patient population will likely be much smaller than projected, and you'll be challenged to cover the start-up investment of your program. A valuable CCM partner company will provide that marketing support for strong enrollment numbers.
4. Net Patient Churn Management
Since enrollment is an ongoing function of Chronic Care Management services, your care management services will also need to be data-intensive so that you can manage patient churn efficiently. Every day there will be the potential for patients to:
- Age-into Medicare, making them eligible for enrollment
- Code a second chronic condition, making them eligible for enrollment
- Choose to unenroll from the program
- Expire from the program
Without the ability to closely manage churn data, you will not be able to maximize your results and your program can quickly become a mess. Unfortunately, almost all practices average negative Net Patient Churn (NPC) in their CCM program, ultimately leading to the dissolution of their program.
5. Patient Marketing
Patient marketing is key to engagement. When patients are aware of a program and the features it offers, they're more likely to take full advantage of the services available. CCM companies should assess patient satisfaction to determine how well the program supports people's needs and where the program can improve. Analytics can play a role with measurements like net promoter score (NPS) — a metric that grades performance based on survey responses.
In addition to patient satisfaction and engagement, a strong CCM program will have an omnichannel interface. Patients should be able to access their CCM program information and features on all their favorite devices, from computers to tablets to smartphones. The ability to experience a program in a patient's preferred format is essential for reaching all types of audiences and keeping patients involved in their care.
6. Clinical Interoperability
Interoperability refers to two or more systems sharing information with one another to create a fully integrated system. In the clinical space, interoperability is essential across platforms to make sure all relevant patient data is shared between platforms — your CCM program should do the same.
Chronic Care Management companies should provide a CCM program and platform that integrates with your electronic health record (EHR). Doing so will allow all care providers to stay connected to patient updates, program adjustments and more, so everyone is on the same page regarding a patient's care. This communication between platforms is critical for managing health risks and improving care outcomes.
7. Analytical Reporting and Support
A successful care management program should be robust. There are a lot of metrics to track and review periodically so that you stay on track. These include clinical utilization, inbound and outbound call SLAs, and dozens of other important performance benchmarks.
Practices are typically strapped for time already, so it can be difficult to find the time to dig into the details of your program. That’s why it’s important to have strong analytical reporting tools and a client success representative or customer support team that can do it for you and assist you as needed.
8. Easy Billing
Setting your billing team up for success will reduce headache and maximize your reimbursements for CPT 99490, Chronic Care Management. It's important to partner with a CCM provider that can automate the billing process for CCM claims. If your billing team is creating CCM claims manually, expect 100 claims to take at least three hours for a seasoned, uninterrupted biller.
If you have thousands of enrolled patients, this pace is not sustainable. The key to easy billing is a data exchange between your Practice Management System (PMS) and your CCM software that can file claims automatically with a few clicks. Removing this responsibility from your clinical staff will free up time and resources for other critical processes.
9. Clinical Team
Your care team will be the heart of your CCM program since they are the ones who perform care coordination for your patients. The work they do is intended to improve the clinical outcomes of patients, resulting in better health as well as reduced readmissions and hospitalizations.
The care team clinicians are responsible for tending to your enrolled Medicare beneficiaries and managing their chronic diseases through preventative care. Your team of clinical staff will need to be large enough to handle the labor involved in running a CCM program daily, including follow-up, building comprehensive care plans and performing a high quality of care. They will need to be fully trained and staffed to handle patient inquiries 24/7, every day of the year.
10. Ongoing Training
Your customer support team should do more than just track your program’s metrics. They will need to be your first line of contact when it comes to any situations that arise or questions you may have. They should be responsible for fully training your team during initial program launch as well as continuously throughout the program. Close communication between you and your customer support team is crucial for a successful partnership.
Choose All-in-One CCM Solutions From ChartSpan
A turnkey, managed solution for Chronic Care Management is the most likely to include all of these features in full. At ChartSpan, we understand the intricacies of CCM, and we provide the system and support your practice needs to implement value-based care for your Medicare patients.
If you or your organization are interested in a CCM service that includes all the most important features for success, consider one of the top Chronic Care Management programs, ChartSpan.
Published: April 7, 2021
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