16 Topics to Consider When Choosing A CCM Vendor

• Who is the primary customer in the Chronic Care Management (CCM) program? (The answer should always be the patient.)

• How will you integrate with my EHR?

• Can you accommodate the bi-directional exchange of patient clinical data and care plans, in and out of our EHR?

• What kind of access privileges to our EHR will we need to give to your team?

• Explain the process you’ll use to extract our EMR demographic reports to identify eligible CCM patients.

• As my CCM vendor, will you automate a billing feed for my Biller so we don’t have to manually bill each transaction?

• How often will we be able to bill CCM claims? Monthly, weekly, realtime?

• What costs will you cover to integrate with my EHR?

• How many times have you integrated with my EHR vendor?

• What do you expect of the practice for training and onboarding?

• Which staff members are required to participate in training?

• Will training/support be on-going after our initial launch?

• Explain the process you will utilize to consent our patients.

• What are your average patient enrollment conversion rates in the first 30, 90 and 180 days of onboarding a new client?

• What percentage of patients do you expect to enroll in CCM?

• How do you ensure exact and accurate communication of copay information to patients during the enrollment process?

• What is your strategy to communicate with our patients prior to enrollment ensuring they know your call is a partnership with our practice and providers?

• Will you call our patients from a ChartSpan number or a local area code similar to ours?

• What, if any, materials or welcome packets are sent to the patient after they enroll explaining the program?

• How often do you follow up with a patient in an effort to enroll them? When do you stop?

• What steps can be taken to correct inaccurate data in our demographic reports so every eligible patient can be contacted?

• Are all patient enrollment and clinical calls recorded, archived and available for our review?

• What are your inbound telephony service level metrics (time to answer inbound patient calls, average amount callers spend on hold, average time to return a voicemail and call abandonment rate?)

• Upon request, how long will it take for you to send us a recorded patient call?

• How many focus groups have you done with seniors to validate their understanding of a care coordination service and what they value most?

• Are you willing to share the results with us?

• How do you measure patient satisfaction and how will that information be shared with us?

• How many patients unenroll monthly from your program by practice?

• How do you train your new clinical staff and how much time is spent in ongoing training for your existing clinical staff?

• How many weeks do your clinicians go through floor shadowing during their initial training before being allowed to interact with patients?

• What are the specific personality traits you have found that make the most effective clinician for this program?

• How many hours did your clinical staff spend in training last month?

• Who heads up your clinical training program and what is their depth of experience?

• Can you walk me through your Quality Assurance program and process?

• How often is each clinician’s performance reviewed?

• How often does your QA team audit each of your clinicians?

• Will you provide your QA audit form with us?

• What are the coaching sessions like between your QA team and clinicians?

• Do you review every call and chart, either with a human being or artificial intelligence software?

• Can we see your rubric scoring sheet?

• In your proforma you provided does it factor traditional patient churn rates, copay patient collection rates, deceased rates, and various payer mixes?

• As my CCM vendor, do you have data that shows the potential impact your CCM program will have on my overall Fee For Service?

• We know that patient deductibles reset in January each year. How do you counsel your clients to manage copay billings during deductible season?

• What steps are taken when a patient asks to unenroll due to deductible costs?

• Do you have a full-time pharmacy team that handles daily medication refill requests?

• Will you alter your CCM medication workflow to accommodate the unique needs of our practice?

• Do you have a free prescription drug savings card that is available for every CCM patient?

• Tell us about your 24/7 nurse triage line.

• What level of clinician operates this and what protocols do they follow?

• Do you use industry standard protocols such as Schmitt-Thompson?

• What are your guaranteed service level metrics for the hotline?

• Can we see a copy of your required Comprehensive Care Plan or Patient Health Summary for a typical patient?

• Besides the per patient CCM fee, have you ever charged a customer any other type of fee?

• Will you charge us any upfront fees?

• Will you cover any potential EHR fees?

• What is your policy if I get a denial for services? Am I still charged?

• Can you demonstrate your CCM software?

• Did you build your software or purchase it?

• Please explain your security and encryption technologies.

• Is your software ONC certified?

• How often do you make changes or improvements to your software and process?

• Do you intend to help us with our MIPS and other quality scores while administering our CCM program?

• Is there any additional cost for your MIPS/quality services?

• Can you explain how CCM supports Value-Based Care Models and how it may increase my participation with my ACO or APM?

• How did your MIPS performance reporting compare to the 2018 national averages.

• Is your system set up to help me with my ACO requirements? HCC scoring? Beneficiary Attribution? Annual Wellness Visits?