When you are considering implementing a Chronic Care Management (CCM) program for the first time, it can be daunting to know which features, functionality, and services are important for an impactful and profitable program. Knowing the top ten features that will make your program a success can prevent you from making an expensive and time-consuming mistake.
What does a successful CCM program look like? You will need to be able to show profitability, improved patient outcomes, and patient satisfaction, as well as allocate dedicated clinical, I.T., and enrollment call center labor. In order to be able to track these key metrics, your program will need to be robust with deep analytics, established performance benchmarks, and a well-coordinated team of technical, clinical, and administrative support personnel. Let’s explore the most important features that should not be overlooked.
Your Chronic Care Management program should have the highest possible security standards in order to protect your patients’ information. All technology and processes related to your program will need to be HIPAA compliant and secure. At the highest level, you should look for a turnkey program that has achieved HITRUST certifications so that you are confident that all aspects of your program are following the appropriate security measures. Effective HIPAA Compliance and Cybersecurity measures are paramount in protecting patient health information. Programs with HITRUST certifications will ensure security is continuously monitored to protect against bad actors and their growing exploits to try to access sensitive health information. Successful data breaches affect patients and cause financial and reputational risks to providers.
Similar to other healthcare programs, care management services must adhere to a strict and detailed level of compliance required by the Centers for Medicare and Medicaid Services (CMS). For CCM, this requires that all employees involved in the program should be trained appropriately in the legal intricacies of CCM and rules that must be followed. In addition, regularly scheduled quality auditing processes are required to ensure that all phone calls and documentation follow the guidelines that Medicare has set in place for Chronic Care Management programs. The ability to archive all CCM enrollment and clinical calls for 10 years is one of the most important features of a well-run CCM program, ensuring the ability to pass compliance audits.
The enrollment functionality of your CCM program is one of the most crucial but often underappreciated keys to success. You will need a team of trained professionals to call your eligible beneficiaries with multiple chronic conditions, educate them on the benefits of the program, and encourage them to enroll. Easy enough right? No, because if you want to maximize your program, you’ll need those same professionals to be skilled in rebuttals and marketing strategies that will produce high enrollment rates. Without this skillset, it’s likely that you will end up with a much smaller CCM patient population. Most practices never achieve their volume expectations and usually fail to cover the start-up investment in their CCM program.
4. Net Patient Churn Management
Since enrollment is an ongoing function of chronic care management services, your care management services will also need to be data-intensive so that you can manage patient churn efficiently. Every day there will be the potential for patients to:
- Age-into Medicare, making them eligible for enrollment
- Code a second chronic condition, making them eligible for enrollment
- Choose to unenroll from the program
- Expire from the program
Without the ability to closely manage churn data, you will not be able to maximize your results and your program can quickly become a mess. Unfortunately, almost all practices average negative Net Patient Churn (NPC) in their CCM program, ultimately leading to the dissolution of their program.
5. Patient Marketing
Patient marketing is a necessary piece of any program. Marketing the program is a necessary tool to educate and improve patient engagement. Without marketing, your patients likely will not understand the benefits of the program, which can lead them to decline the program when approached for enrollment. If they do enroll, marketing is important so that patients are constantly reminded of the benefits they are receiving and how to best utilize the program.
6. Clinical Interoperability
To achieve clinical interoperability, your care management program will need to have a clean integration with your EHR. This will allow the patient care plans to be stored within the EHR and for bi-directional data to flow effortlessly. This applies for clinical as well at billing data. There are an abundance of EHR systems, so be sure that your CCM program is able to integrate with yours specifically.
7. Analytical Reporting and Support
A successful care management program should be robust. There are a lot of metrics to track and review periodically so that you stay on track. These include clinical utilization, inbound and outbound call SLAs, and dozens of other important performance benchmarks. Practices are typically strapped for time already, so it can be difficult to find the time to dig into the details of your program. That’s why it’s important to have strong analytical reporting tools and a client success representative or customer support team that can do it for you and assist you as needed.
8. Easy Billing
Setting your billing team up for success will reduce headache and maximize your reimbursements for CPT 99490, Chronic Care Management. It is recommended that you work with a CCM provider that can effectively automate the billing process for CCM claims. If your billing team is creating CCM claims manually, expect 100 claims to take at least three hours for a seasoned, uninterrupted biller. This is hardly scaleable for a large organization with 5,000 enrolled patients. You would need a FTE just to manage CCM billing alone. However, with a Data Exchange between your Practice Management System (PMS) and your CCM software, the process for pushing 100, completed, CCM claims to your PMS should take just a few simple clicks! This will free up much needed resources for your organization.
9. Clinical Team
Your care team will be the heart of your CCM program since they are the ones who perform care coordination for your patients. The work they do is intended to improve the clinical outcomes of patients, resulting in better health as well as reduced readmissions and hospitalizations. The care team clinicians are responsible for tending to your enrolled Medicare beneficiaries and managing their chronic diseases through preventative care. Your team of clinical staff will need to be large enough to handle the labor involved in running a CCM program daily, including follow-up, building comprehensive care plans, and performing a high quality of care. They will need to be fully trained and staffed to handle patient inquiries 24/7, every day of the year.
10. Ongoing Training
Your customer support team should do more than just track your program’s metrics. They will need to be your first line of contact when it comes to any situations that arise or questions you may have. They should be responsible for fully training your team during initial program launch as well as continuously throughout the program. Close communication between you and your customer support team is crucial for a successful partnership.
A turnkey, managed solution for Chronic Care Management is the most likely to include all of these features in full. If you or your organization are interested in a CCM service that includes all the most important features for success, consider one of the top Chronic Care Management programs, ChartSpan.
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