The push for value-based care has driven practices to try new preventative programs and processes that claim to provide better care for their patients. With the population of patients who need additional care rapidly growing, it can be a difficult change. For some, it can be overwhelming to decide which programs and changes, if any, are worth the time and investment and will actually produce positive outcomes for their patient population.
In 2015, the Centers for Medicare & Medicaid Services (CMS), introduced reimbursement for offering Chronic Care Management (CCM) services, a preventive care program for Medicare patients with multiple chronic conditions. In this article, we will explore the patient benefits of a CCM program and assess its worthiness as an effective value-based care program.
1. Access to Care
Most patients practice a reactive approach to their health, visiting their provider’s office only when they are sick. In a Chronic Care Management program, the emphasis is on proactive, preventative care. The CCM care team proactively performs monthly telephonic and electronic check-ins with enrolled Medicare beneficiaries. Medicare requires twenty minutes of clinical staff time to be performed and documented in order for CCM to be billable under CPT code 99490 (G0511 for RHC/FQHC) each calendar month. This proactive approach allows clinicians to provide preventative services specific to the CCM patients’ chronic conditions before their health worsens.
In addition to preventative services, Medicare requires that CCM services include 24/7 access to care, such as a nurse hotline. This two-pronged approach of reaching out proactively for preventative care but also providing extended availability makes Chronic Care Management a powerful program. CCM’s heightened access to care is intended to reduce or slow functional decline, and is proven to reduce hospitalizations1 and emergency room visits.3
2. Healthcare Savings
Even with a small monthly coinsurance requirement, patients who are eligible and enrolled in a CCM program are shown to reduce their annual healthcare expenditures.2 CCM services can help patients reduce their overall healthcare spending in multiple ways:
- Preventative care keeps patients healthy and out of the hospital.
- A 24/7/365 nurse line reduces the likelihood that a patient would go to the emergency room for a non-urgent issue.
- The 24/7 care management access allows patients to ask questions directly to qualified health care professionals, without having to go in for an office visit.
- The care team can help assist with finding less-expensive prescription options.
Medicare claims data shows us that with CCM, unnecessary hospital visits can be reduced by at least 4.7%1 and ED visits by 2.3%.3 Additionally, Chronic Care Management saves Medicare approximately $74 per patient, per month.2
3. Achieving Healthcare Goals
Care management clinicians work to equip patients with the tools they need for self-management of their chronic conditions. The clinicians address each patient’s chronic conditions individually and together with their primary care or specialty provider, build goals to improve their health outcomes. These goals are then documented in a comprehensive care plan and referenced during each interaction with the patient.
Chronic Care Management requires the construction of a comprehensive care plan that is accessible at any time. This plan is an all-encompassing document where the care coordination team documents every interaction with the patient. It also includes the patient’s medical history, list of healthcare providers, health conditions, and a medication list. The comprehensive care plan is stored like a medical record in the provider’s electronic health record (EHR) and is available to the patient, provider, and approved caregivers.
The benefits of CCM are vast, especially for patients. Preventative care with extended resources leads to overall better health and access to care. Access to care leads to less hospitalizations and emergency room visits, ultimately reducing overall healthcare spending. Better care helps improve patient outcomes and helps patients achieve healthcare goals that are specific to their needs. If providers intend to move towards effective, evidence-driven value-based care, a program like this is not only crucial to patients with chronic conditions, but to our healthcare system as a whole.
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