The State of Chronic Care Management in Rural Health Centers

In a recent Porter Research study, nearly half (47%) of RHCs reported that they do not offer a chronic care management (CCM) program to their patients, even though the program offers $67/patient/ month* in much-needed recurring revenue. It’s a stunning statistic considering CMS claims data shows patients enrolled in a CCM program cost less and spend less on out-of-pocket health expenses.

So, why are so few Rural Health Centers (RHCs) offering CCM programs?

Rural Health Centers (RHCs) face a number of challenges impacting their ability to provide proactive or preventative care management services to the communities they serve. Limited access to qualified clinical professionals, additional costs and administrative burdens associated with managing a program, and even the widely dispersed nature of their patients all contribute to the unique challenges RHCs must overcome.

How are those RHCs that are offering CCM performing?

Based on the Porter Research findings, 73% of respondents who do offer CCM services are relying on their own resources and their EMR system to manage the program. This is despite the fact that the vast majority of EMR systems are not equipped to handle the unique needs of chronically ill patients nor do RHCs typically have access to the volume of qualified resources required to manage a successful CCM program. This do-it-yourself (DIY) approach places the burden on the already overburdened resources, which typically results in fewer patients receiving access, frustrated administrators, and ultimately program abandonment.

The purpose of this blog is to explore how RHCs can optimize the health of their Medicare patients by deploying a care management program without jeopardizing their current patient care responsibilities.

The Growth of CCM in RHCs

Under the Medicare Care Management program, the Chronic Care Management (CCM) benefit has evolved since its inception nearly four years ago, particularly when it comes to the benefits and policies specific to RHCs. As the payment rate continues to climb annually and the billable services continue to expand to include things like Virtual Communication Services**, CCM programs are becoming more attractive to RHCs. Even today, there is significant legislation in Congress, called Seniors’ Chronic Care Management Improvement Act (HR 3436), that would eliminate out-of-pocket expenses, such as co-pays, that seniors are required to pay in order to access care coordination services.

When you combine the push to eliminate barriers to CCM services with the RHC Modernization Act that was introduced in May of 2019, there is hope for the 4,200 nationwide RHCs that are often responsible for providing primary care and preventative care services to the millions of Medicare and Medicaid beneficiaries to live in rural and underserved communities today.

How To Deploy a CCM Program

But as proof of the benefits to providers, patients and payers continue to pile up, many RHC leadership teams are still asking, “How can we possibly add another program to our already strapped resources? Where will we get the funds to pay for the extra clinical and administrative staff we need to manage a CCM program? Do we really want to subject ourselves to more regulatory reporting requirements?”

ChartSpan has the answers. As the largest care coordination service program in the country, ChartSpan offers RHCs complete CCM program management. The services begin with identifying eligible patients who meet the complex eligibility requirements. Next, ChartSpan’s experienced team of clinicians work as an extension of your team to enroll patients and educate them on the services they now have available. These services include everything from 24x7 access to a clinical expert, transportation assistance, prescription assistance programs, community services and even finding appropriate home care services. ChartSpan services even include support for billing code G0511. The ChartSpan team of seasoned, clinical experts have years of experience in providing chronic care management services to patients and follow rigorous quality standards that ensure the highest quality care is delivered on every call or contact.

Another piece of good news is that the Porter Research study indicates that more RHCs are considering CCM programs. In fact, 70% of RHCs who do not currently offer CCM services are hoping to do so in the future, with 30% of these claiming to implement a program within the next 12 months.

If you are one of these RHCs that does not have a CCM program, or one that does but you feel that there is room for improvement, contact us today for a free assessment.

Resources:

* NARHC, What’s new for RHCs in 2019? https://www.web.narhc.org/News/27712/Whats-New-for-RHCs-in-2019

** CMS, Virtual Communication Services, https://www.cms.gov/Center/Provider-Type/Rural-Health-Clinics-Center.html