The Shift to Value-Based Care
The past fifteen years have proven a slower shift towards value-based care than what most have hoped. Even though the concept was introduced in 2006, there are still healthcare organizations and practices that struggle to make well-care a priority because sick-care is consuming all their time and resources. This is largely due to the way the healthcare system is designed – reactionary vs preventive. Many providers and practices are already overwhelmed, so it can be difficult to fit additional, preventative medical care into their schedules with a revolving door of sick patients.
Despite the best of intentions to execute value-based care initiatives, overwhelmed practices can quickly watch their value-based care efforts move to the back of the priority list or become ineffective. Thankfully, the Centers of Medicare and Medicaid Services (CMS) have designed special programs that encourage practices to improve their quality of care, without an overwhelming operational burden. One of these programs is Chronic Care Management (CCM), which CMS began reimbursing for in 2015. CCM offers a substantial revenue benefit since providers are reimbursed for each enrolled CCM patient, per month. Providers will earn hundreds of dollars per year, per each enrolled CCM beneficiary with Fee-For-Service and Shared Savings, combined. Exploring CMS’ value-based programs, like CCM, can provide practices with a structured way to provide value-based care that ultimately improves patient outcomes while also providing a supportive revenue stream.
Chronic Care Management, a Value-Based Program
Chronic Care Management was designed to provide remote care to Medicare beneficiaries who have two or more chronic conditions. Since the care is provided remotely under general supervision, providers are able to partner with a third party company that specializes in running CCM programs. In fact, programs like CCM are typically the most beneficial to practices when they partner because it removes the burden of having to use practices’ limited time and labor resources, yet still provides needed, additional care to patients without interrupting practice workflow.
In a CCM program, healthcare professionals work to close the gap between enrolled CCM patients and their providers. This includes proactively reaching out to gather health information and assist with any patient needs like refilling prescriptions, setting appointments, and requesting health records. Every month, the care team, composed of certified clinicians, will work on a comprehensive care plan for each patient that includes all patient information and is stored in the electronic health record (EHR). The care team works with the patients’ healthcare providers to set healthcare goals, follow-up on them each month, and document any changes in the care plan. This is beneficial to the provider as it often affects quality improvement efforts as well. All decision-making is still done by the provider, but the CCM team acts as an additional resource that helps close any gaps in care.
While some providers may be hesitant to trust a program that provides patient care remotely, Chronic Care Management as a value-based program has been proven to improve patient outcomes. Studies have shown that patients enrolled in a CCM program showed reduced hospitalizations by nearly 5%, reduced emergency department visits by 2.3%, and increased preventative care E&M encounters by 8%. This extra level of care is also expected to reduce hospital readmission rates since patients are able to better manage their chronic conditions and have the support to avoid decline. These numbers can make a huge difference in the healthcare system as the aging population continues to grow.
Better patient outcomes also make a substantial impact on costs. Taxpayers save $74 (gross) and $30 (net), per patient, per month when patients are enrolled in CCM for at least a year. Patients can also expect to see lower costs out-of-pocket since they are avoiding hospital readmissions and ED visits, as well as getting guidance on where to find cheaper prescriptions.
Providing better quality of care does not stop at improving patient outcomes and lowering costs. It requires the patients to actually be happy about the additional care they are getting. Patient satisfaction is a critical part of any healthcare program, but can be especially important in a program like Chronic Care Management, since the patient is required to pay a small copay to be in the program. CCM can help patients feel more connected to their providers and encourage patient engagement. A better patient experience can prevent patient turnover and overall better care. It’s important to track patient satisfaction as a metric for your Chronic Care Management program because if patients are unhappy, they will leave the program, leaving their change of improving health outcomes in the dust.
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