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Can CCM Services Help Providers with Medical Malpractice Insurance Premiums?

Medical Malpractice Insurance Premiums - The Unavoidable 

For anyone who has owned or run a healthcare delivery organization, medical malpractice insurance is just part of the game. It is a necessary cost item that protects both patients and providers. However, the burden of escalating premiums in the double-digit range is bearing down on the independent physician landscape. And while paying those premiums each month can oftentimes cause consternation, it helps avoid financial ruin liability claims. So what can practices do - and quickly?

Thankfully, there is a potential way to offset such high, monthly premiums through “good behavior.” Similar to a home insurance carrier that discounts a homeowner’s rate due to an installed security alarm, medical malpractice insurance carriers can reward providers for implementing various preventative services and solutions. Carriers can reward a practice that takes the extra step to practice preventative behaviors because they know it will lead to better outcomes and fewer claims.

When starting a practice or renewing annual policies, carriers will send out a questionnaire to gauge the current risk profile and identify preventative activities or programs that would garner premium discounts. This questionnaire is lengthy but covers a multitude of opportunities to identify systems or processes in place that can potentially lower a practice’s risk score, and ultimately their insurance premiums.

Enter, ChartSpan’s Chronic Care Management (CCM) services. CCM is a preventative, care coordination program launched by CMS in 2015. The program offers a monthly reimbursable code for providers who meet the 20 minutes or more of non-face-to-face clinical care. To qualify, patients must be diagnosed with two or more chronic conditions, have been seen within the last twelve months, and have Medicare Part B or C as their primary insurance.

Over the last four years and with nearly 30,000,000 billable minutes to its name, ChartSpan has become the largest CCM vendor in the U.S. Their robust CCM program goes above and beyond the minimum required 20 minutes of care by offering a variety of value-adds like a 24/7 nurse line, appointment scheduling, refill assistance, and software that will keep all enrolled patients’ personalized healthcare plans updated in the practice’s EHR.

Medical Malpractice Insurance Premiums - The Areas of Opportunity

The services included in a fully-managed Chronic Care Management program like ChartSpan’s strongly coincide with several factors that are considered when calculating a practice’s risk score for medical malpractice insurance.

For example, one common topic addressed in risk-assessment questionnaires is access to care after business hours. Practices may or may not have a way for patients to communicate after-hours, but even if they do, it is most likely routing patients to another phone number or answering machine. With ChartSpan CCM, patients will have 24/7 access to care through a live, nurse hotline, even when their providers are unavailable. This gives practices the strongest after-hours communication possible.

Carriers also look for extensive clinical documentation of these after-hours phone calls, which ChartSpan provides.

Another factor considered in risk-assessment questionnaires is patient self-management and health literacy. This can be difficult to approach in a busy practice, especially for patients who do not visit regularly. Carriers will look for processes in place that can address patients in a consistent and frequent manner.

The following checklist was included on a main carrier’s risk-assessment questionnaire as a list of important tools used to support patient self-management and health literacy:

• Care checklists
• Written protocols for care management contingencies likely to arise
• Red-flag lists for when to call a member of the practice team

An important benefit of ChartSpan’s CCM program is that the ChartSpan team reaches out to enrolled patients every single month to discuss condition management, answer any questions, and encourage a healthy lifestyle based on personalized health goals. ChartSpan develops a patient healthcare summary that covers a patients’ complete health status and provides a care plan with achievable goals. Not only do team members discuss the healthcare summary with patients each month, but they also have a system in place to identify urgent needs - similar to a red-flag list.

ChartSpan’s CCM team also conducts various assessments while speaking to patients that can identify barriers to patient self-management, such as financial issues or lack of social support. The team then takes an extra step to find resources that may help the patient with their specific needs.

Medical records and protected health information (PHI) are another major topic covered in a risk-assessment. One carrier lists the following as a crucial element to managing medical records:

“A personal health assessment is completed for each patient that includes patient life activities, behaviors, and preferences that may influence the patient’s health, functional assessment, psychological assessment, social resources, environmental assessment, and health literacy.”

If this sounds familiar, it’s because this is covered in ChartSpan’s patient health summary, which is updated monthly. An important detail about the patient health summary is that it is updated in each patient’s chart, which resides in the practice’s EHR through a data feed. Any changes, recommendations, and treatment plans are updated and accessible to ChartSpan and the patient’s provider at any time.

Medical Malpractice Insurance Premiums - The Investigation 

The ChartSpan team has endeavored to explore creative avenues when it comes to providing value. One of those value propositions is the potential of a better medical malpractice premium.

To investigate the possible overlap between CCM and medical malpractice insurance premiums, ChartSpan began consulting with Professional Risk Associates, a top healthcare insurance broker based in Midlothian, Virginia. Together they began to look deeply into the reporting structure and outcome data within ChartSpan’s CCM program. After a lengthy analysis, Professional Risk Associates ascertained that ChartSpan’s CCM program can potentially help augment risk scores for providers and help provide possible discounts or credits with their policies. In addition to those previously mentioned, examples of areas that were identified were communication, scheduling and follow up, patient self-management, medication management, physician/patient relationship, and business operations.

After completing the analysis, the team at Professional Risk Associates sat down with leaders at various medical malpractice carriers and underwriters and presented the theory and findings.

One carrier commented, “It is always a benefit to demonstrate improvements with quantitative data.”

Although every carrier is different and circumstances will vary, the theory that ChartSpan’s CCM program could help address medical malpractice premiums is very real. If you are interested in learning more or would like a free consultation to see if your current CCM program could potentially impact your scores click on the request information button below.