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Why Care Management Software to Reduce Workload Is Only Half the Battle

Summary:

• Care management software can assist with determining eligibility, creating and storing care plans, and time tracking for care management programs.
• However, software alone can’t reduce the workload for clinical staff, who must provide 24/7 inbound care, perform proactive outreach, address quality measures, and manage discharges.
• If you’re worried about workload for your staff, full-service Chronic Care Management or Advanced Primary Care Management may be a better option. 

Medicare care management programs offer ongoing, preventive care for patients and much-needed reimbursements for practices—but they can also create work for clinical staff and providers. Because of this, practices frequently search for care management software that can reduce their workload.

Software-only solutions can assist with time tracking, documentation, and creating lists of eligible patients. However, they still require clinical staff to perform enrollment, create and update care plans, reach out to patients on a regular basis, and perform administrative tasks. All of this work can cost existing clinical staff hundreds of hours per year.

If your staff doesn’t have this kind of time available, your best option may be to pursue a partner that offers both care management software and services. Keep reading to discover how a dedicated care management partner can reduce workload with comprehensive support. 

Time Savings with Care Management Software and Services

Care management software can help you follow Medicare requirements for Advanced Primary Care Management (APCM), Chronic Care Management (CCM) and other care management programs. However, it can also add to staff workload. 

ChartSpan estimates that fully managed care management services can save roughly 674 hours of staff time per year for every 1,000 patients served. That amounts to 13 hours of staff time every week that must be spent on care management. 

But why does care management software, without additional support, consume so much time for clinical staff? We’ll review what software can and can’t do and how a fully managed service can reduce the time practice staff spend on administrative tasks and documentation. 

Managing Eligibility

Care management software can help you determine which patients are eligible for APCM and CCM quickly, so you don’t have to manually dig through your Electronic Health Record data. Advanced software parses patient data from your EHR to determine which insurance coverage patients use, how many chronic conditions they have, and whether they have any special factors, such as living in a nursing home, that would disqualify them. 

However, while determining insurance coverage or chronic conditions may seem simple, every practice has individual needs that have to be taken into account. Chronic Care Management and Advanced Primary Care Management both require that the patient has Medicare, but some Medicare Advantage plans may need to be excluded from your eligibility list. 

Similarly, for CCM, you can determine whether the patient has two or more chronic conditions from a list of many options. However, for APCM, you must stratify the patients into levels:

Level 1: zero or one chronic condition

Level 2: two or more chronic conditions

Level 3: two or more chronic conditions and a Qualified Medicare Beneficiary (QMB)

To uncover whether a patient is a QMB, you’ll need access to the HIPAA Eligibility Transaction System (HETS). A vendor may be able to provide this access, but this will likely be part of a full-service offering. For example, ChartSpan offers HETS access as part of our full-service APCM program.

While some patients, such as those living in a full-time care facility, are always excluded from care management programs, some practices have specific requests for who they’d like to exclude. With software, your practice staff will have to manually pull patients out of the eligibility lists every time you run a check for new patients.

Additionally, you’ll need to run checks to find new, eligible patients on a regular basis, a task a full-service program performs for you. ChartSpan checks for newly eligible patients, according to your practice’s preferences, sends the eligibility list for review, and performs enrollment services for the eligible patients each month, saving your staff time.

Performing Enrollment

Once you have determined which patients are eligible for APCM or CCM, the next challenge is enrolling those patients. Enrollment needs to be continually performed as new patients join Medicare, and the enrollment process requires educating patients before you reach out to obtain their consent digitally or via phone. 

Enrollment is one of the areas where software alone falls short. While software can identify which patients qualify for care management, it cannot create marketing materials to educate those patients, record ringless voicemails to share information about the program, or reach out to patients via phone to ask if they want to enroll.

All of these functions can be performed by a full-service care management program with dedicated enrollment staff. 

Dedicated partners also help ensure consistency for mandatory consent qualifications: 

• That patients can leave the program at anytime
• Patients can only be enrolled under one provider
• Patients may have cost-sharing responsibilities
• For APCM, that the billing provider agrees to serve as the patient’s primary point of care. 

Failing to share these consent requirements and document patient consent through voice recordings or saved, signed forms can lead to compliance violations. But enrollment goes beyond reciting compliance requirements. Enrollment specialists must explain the program to patients, making it clear what benefits they’ll receive and how those benefits could impact their long-term health, before asking for their consent to enroll.

This process is time-consuming, especially for clinical staff who have other obligations in office. Enrollment alone constitutes a significant amount of work for clinical staff before clinical care begins. 

Clinical Care and Reducing Staff Workload

Once patients are enrolled in CCM or APCM, software can help track and document the time spent with each patient. For CCM, this ensures you provide 20 minutes of care management to each patient, each month; for APCM, it allows you to document that all service capabilities were offered every month.

However, software alone won’t reduce the workload of each program’s service requirements. Chronic Care Management and Advanced Primary Care Management both require a 24/7 inbound care line that operates on evenings and weekends and proactive outbound care management that takes place throughout the month. Inbound and outbound care each present challenges and additional workload for staff. 

Staffing the 24/7 Inbound Care Line

To successfully run APCM and CCM, you will need to staff a phone line that can answer patient calls quickly on nights, weekends, and national holidays. The clinicians who manage that line need to be prepared to assist patients with medication refills, appointments requests, and Social Determinant of Health needs. 

They’ll also need to be able to quickly respond to emergencies. At ChartSpan, we have on-call Registered Nurses who can join the call to perform inbound triage using Schmitt-Thompson protocols, which have 90% accuracy for ER referrals. 

If you choose not to have a partner, you’ll need to ensure you have staff in-house to perform triage and to notify providers of any emergent or unexpected symptoms experienced by their patients. 

When ChartSpan launched an APCM program, 95% of enrolled patients required assistance with a medication refill, 48.4% required appointment assistance, and 37.4% had needs that required provider notification. For a practice with 1,000 Medicare APCM patients, this could result in hundreds of requests for appointment assistance and almost 1,000 requests for medication refills managed by inbound care line staff.

Staffing for Outbound Care Management Support

Staffing the inbound care line alone presents a heavy workload for clinical staff, but Chronic Care Management and Advanced Primary Care Management also require proactive, outbound care management to help patients manage their health and to prevent escalations.

The outbound care requirement includes creating a care plan with the patient, drafting care goals, and reinforcing those care goals over time. It also includes checking on patients’ medication adherence, reviewing health records, sending educational information on patients’ conditions, and identifying gaps in care that can be addressed. Care plans and documentation of the additional care can be recorded in care management software or in the EHR.

For Chronic Care Management, staff must perform at least 20 minutes per month of this clinical work, which can be tracked with software but must be performed by clinical staff. Advanced Primary Care Management removes the time requirements but adds the requirement to offer population health analytics and address gaps in care, as well as the requirement to perform discharge management when patients are released from the hospital. 

The Workload Required for Quality and Population Health Analytics

Advanced Primary Care Management evaluates success based on quality outcomes. Because of this, the program requires practices to perform population health analytics on their patients, identify gaps in care, and address those gaps proactively to improve their quality measures. 

A successful quality program requires a combination of software and clinical services. Software must be used to identify widespread gaps in care across a given patient population, to record assessments performed, and to track follow-up for those assessments, where needed.

When ChartSpan launched an APCM program, clinical staff addressed gaps in care for 100% of patients, with most patients having at least two gaps addressed each year. The most common gaps in care were missing medication adherence assessments (38.5% of patients), missing cognitive assessments (30.4%), and influenza immunizations (20.4%). 

ChartSpan care managers were able to perform medication adherence assessments and cognitive assessments and notify the provider if the patient needed further screening and support. APCM care managers were also able to schedule influenza immunizations for patients who were missing the immunization and wanted to receive it.

Proactive quality initiatives require hundreds of hours of clinical staff time per year that overworked practices often aren’t able to spare. Therefore, quality is an area where software and services support are especially essential. 

Discharge Management Support

The other major feature that separates APCM from CCM is APCM’s required discharge management. Under CCM, care managers can provide support to patients leaving the hospital, if they’re aware patients have been discharged.

However, under APCM, this support is mandatory. Your practice must have technology to identify when patients have been discharged. Clinical staff then must:

• Follow up with the patient within 7-14 days 
• Attempt to schedule a follow-up appointment
• Check on whether patients have medication or Durable Medical Equipment needs
• Arrange resources like meal delivery or transportation
• Notify the provider if the patient needs additional support

Identifying discharges quickly and offering comprehensive support can have a dramatic impact on patients’ readmission rates. In ChartSpan’s discharge management program, 89% of patients who received DM support did not need to return to the hospital within three months. 

However, preventing 89% of readmissions is only achievable with clinical staff who have the technology to receive discharge notifications immediately and who have sufficient time to respond to those notifications in detail and provide resources. A combination of services and software will offer staff more support than only software for discharge management and other APCM capabilities. 

How to Reduce Care Management Workload for Your Practice Staff

Care management software has a vital role to play in determining patient eligibility, tracking care plans and documenting time spent on care. However, it can’t remove the workload of managing a 24/7 care line, supporting patients with care plans and care goals, identifying gaps in care, and performing discharge management. 

If you have sufficient staff or can hire new staff to take on these care management responsibilities, you can launch care management with only software support. However, if you don’t have staff who can manage this additional workload, a vendor who combines software and services may be a better solution.

You can learn more about ChartSpan’s full-service solution for Advanced Primary Care Management and how it impacts patients in our recent whitepaper.