There is little doubt your health system or practice understands the value of providing preventative patient care. The Medicare armada of preventive services and shared savings programs has set sail…and it seems everyone is on board. But at what cost? The proverbial question seems to be what infrastructure and labor is required to be successful in a value-based program and will I recoup that investment?
Candidly, most preventive programs sound great in theory, but public claims data show most do not successfully improve patient outcomes or reduce costs. Most importantly, the genuine attempt to mitigate high acuity clinical care among patients with chronic illnesses would appear at face value to be a steep challenge, requiring a significant investment.
Medicare’s Chronic Care Management (CCM) program, however, was designed to address the two interrelated pain points: rising health risk for the chronically ill and a lack of reimbursement to engage providers in preventative health management. In 2015, Medicare created CCM as a reimbursable program to incent providers to focus time and attention on disease management and contributing risk factors. The benefits of the program are vast and have demonstrated positive outcomes for enrolled patients and are shown to be profitable for providers when executed at scale. That said, running a successful CCM program is extremely complex and requires infrastructure investments to maintain compliance and resources to organize a network of providers to execute the minimum requirements of the program: 20 minutes of care per month delivered to enrolled patients.
At ChartSpan, we’ve identified the complexities of Chronic Care Management and have spent the past five years perfecting our processes and investing in technology that provides a fully managed CCM service that imposes no added burden on practice resources. Our turnkey solution handles every step of the program, from identifying eligible patients in your EHR to providing around-the-clock access to nurses to respond to patient needs 24/7. Partnering with ChartSpan can help grow your program easily and faster than trying to launch and maintain the program on your own. Read on to learn how an outsourced partner can manage the workload, lifting patient demand off your staff to create added capacity for additional E&M encounters.
Participation in Chronic Care Management has been proven to significantly improve patient outcomes. Patients enrolled in a CCM program, compared to those not enrolled, show remarkable improvement in the management of their chronic conditions. On average, data has shown a 20% decrease in hospital admissions and 13% decrease in emergency room visits for enrolled CCM patients. In addition, we see a 45% decrease in hospital readmissions specific to congestive heart failure.
These results can be credited to the care team that organizes resources for enrolled patients every day. With a fully staffed care coordination team devoted to patient support, it makes it easy to deep-dive into each patient’s specific diagnosis and help create a comprehensive care plan to improve their health. At ChartSpan, our 24/7 care coordination team uses SMART goals to build these care plans and follows Schmitt-Thompson protocols to determine the optimal care path and direct patient needs to the appropriate source. We understand that improving patient outcomes is about addressing day-to-day challenges.
In a recent Porter Research study, over half of the providers surveyed reported that they do not currently have a Chronic Care Management (CCM) program. Of those who did not have a program in place, 50% of respondents claimed that the opportunity for revenue would be the number one motivator to get them started. The great news: one of CCM’s top benefits is a new, reliable revenue stream.
Reimbursement rates vary by state and practice type, but with proper billing discipline, a positive revenue stream is guaranteed, even with a smaller patient population. For example, a RHC practice in Mississippi that partnered with ChartSpan to enroll 400 patients in their CCM program realizes more than $161,000 in annual net profit.
Revenue will ultimately depend on the volume of patients enrolled, which is why it’s important to have a strong system in place to obtain patient consent to participate in your CCM program. Outsourcing this critical function to a CCM partner is beneficial. ChartSpan has learned that the best way to enroll CCM patients is with a group of trained Enrollment Specialists who are experts at engaging patients on the benefits of Medicare’s CCM services and overwhelming common patient questions. Our strategies are so effective that on average, 60% of eligible patients enroll, while most practices that attempt an in-house CCM program enroll only 10% of their eligible patients.
The benefits of Medicare’s CCM program offer a solution to two difficult challenges. Yet, we find that many practices do not succeed or even attempt to provide a CCM program because of the daunting amount of work and resources that it requires. With a turnkey solution like ChartSpan’s care coordination services, providers can confidently trust that their patients will have added resources to address their chronic health conditions through a fully compliant partner. Learn more by scheduling a no-obligation consultation here.
*Source for all data: HealthAffairs,Vol.36 | No.7 July 2017, Bending The Spending Curve By Altering Care Delivery Patterns: The Role Of Care Management Within A Pioneer ACO- John Hsu and AHRQ, Designing and Implementing Medicaid Disease and Care Management Programs, Section 8: The Care Management Evidence Base
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