Chronic Care Management or CCM came to prominence in 2015 when the Center for Medicare and Medicaid Services (CMS) acknowledged its value which resulted in the introduction of the Current Procedural Terminology (CPT) codes for reimbursing chronic care services. Initially, uptake was slow, prompting CMS to continue to push for reimbursement rate increases to entice more providers to adopt the program.
Chronic Care Management or CCM is defined as the non-face-to-face services provided to Medicare beneficiaries who have two or more significant chronic conditions. Done right, it provides care during the crucial time in-between office visits. CCM not only brings revenues into the practice but it optimizes chronic patient care with multiple touchpoints to ensure compliance to care instructions.
CCM is an innovative strategy to deliver care to the most high-cost and high-risk patient population. Primary care physicians have come to see the true value of CCM in improving patient medical outcomes and financial incentives, not to mention reducing costs by decreasing hospitalizations, unplanned ER visits, and inpatient readmissions.
Now, the questions faced by physicians are more in line with the following:
- Is now a good time to start a CCM program?
- What technologies are utilized to optimize CCM?
- Who among my patients is eligible and most likely to participate?
- Is insourcing viable and cost-effective?
- Is outsourcing my CCM services a much better solution?
CCM Questions That Need Answering
Physicians recognize that embracing CCM is inevitable for the benefits they provide to them, their patients, and the entire healthcare system. With CCM, patients will be healthier and providers will have extra cash flow from billable CCM services, while healthcare costs will be drastically diminished due to better patient outcomes. Every practice should implement CCM. It is something that needs to be done and requires careful planning to be successful and profitable.
To get started with CCM, we go back to the questions listed above.
Is now a good time to start a CCM program?
CCM may have started out as a high volume, low reimbursement, and high-touch business model, but not anymore. The health benefits are genuine and so are the financial rewards especially since CMS has made drastic changes to CCM reimbursement rates with more than a 50% increase as stated in the 2022 Final Rule. Take for example the CPT code 99490, which is a basic CCM activity requiring a minimum of 20 minutes of time spent by clinical staff to provide care. The rate has gone up by more than 50%. Meanwhile, CPT code 99487 for the initial 60 minutes of complex CCM is up by 41% and code 99489 for every additional 30 minutes of clinical time for each month is up by 56%. The untapped revenue from non-face-to-face services is real because CMS means business in pushing for widespread CCM adoption.
What technologies are utilized to optimize CCM?
To answer this question, we need to look into what CMS requires and what patients need. In 2017, CMS changed the CMS-certified EHRs as a requirement. Naturally, a certified EHR will still record clinical information like demographics, medications, and allergies. However, there is no specific requirement as to the technology for sharing care plan information since many small and rural practices have yet to fully utilize EHRs. Fax or mail can still be used as long as the information is shared when it is needed.
For chronic care patients, a high-touch patient engagement strategy is needed to conduct regular health check-ins, coaching, and close monitoring. The goal has always been to prevent acute care episodes. With the advent of telehealth, the challenge now is to make the same high-touch approach to be virtual. Providers can leverage the following patient engagement technologies to provide chronic care.
1. Medication Adherence Digital Tools
Most chronic care patients require multiple medications. Keeping track of medication adherence can be challenging, which a dedicated app can resolve. It is also helpful to synchronize medications, which allow for multiple prescriptions to be filled on the same day to avoid visiting the pharmacy for different medications in just a short duration. Finally, it is important to have a virtual strategy that could detect non-adherence and for it to work, it should suit patient preferences as well.
2. Remote Patient Monitoring (RPM)
RPM is helpful to clinicians in collecting patient data and providing remote care. There are many devices in the market nowadays like wearable devices, Bluetooth or cellular blood pressure cuffs, or blood glucose monitors. These devices interoperate with the EHR for easy review by clinicians so that the necessary interventions can be completed. However, there are logistical and financial challenges that await providers in integrating RPM into their CCM. These devices can be costly, adding to the total cost are the consumables as well as storage and shipping.
3. Video Visits/Virtual Consultations
Telehealth has paved the way for providers to have meaningful interactions with their patients particularly in providing health coaching to their chronic care populations. Though a video screen separates them, a strong provider-patient relationship can be easily established.
4. Secure and Compliant Messaging Tools
Using a direct messaging tool can push for healthy patient behavior, answer quick questions, or remind about appointments. Members of the clinical team can do quick check-ins, give coaching tips, or make inquiries when patient data from RPM devices are irregular. Naturally, it is crucial to outline the best practices in using the technology so as not to overwhelm the physician with multiple messages or requests.
Who among my patients is eligible and most likely to participate?
CMS states that Medicare beneficiaries are eligible if they have two or more chronic conditions expected to last at least 12 months or until death. Without proper management of the patient’s condition, the patient could be at risk of death, severe complications, or functional decline. You can identify the eligible patients through the EHR and ask for their consent to start billing for CCM services. Oral consent is accepted if documented.
In addition, patients are responsible for a 20% co-insurance unless they have supplemental insurance or Medicaid, which could cover any CCM services. One of the best practices to entice patients is to focus on specific diagnoses from the list of chronic illnesses like COPD, Diabetes, or CHF and then conduct an initial conversation about the benefits of CCM. Setting up a phone line so patients can ask questions about CCM also has been known to be effective.
Is insourcing viable and cost-effective?
Insourcing your CCM provides you with closer oversight and establishes direct relationships with your patients. For a team-based approach under the guidance of the patient’s physician, you would need non-physician practitioners. They will conduct the monthly patient engagement, coordinate treatments, develop care plans, and more.
It should be noted that the work hours of these practitioners can be extensive. CMS requires a registered nurse, a licensed practical nurse, a certified medical assistant, and health coaches. This could entail hiring new staff to start your CCM program, which is an additional expense, but if your care team engages patients then this could drive enrollment up. Note that enrollment may not be high at the onset, but a small population is easy to manage. In time with more effort and promotion, your CCM program can grow.
Essentially, insourcing is an option but the costs can be immense from the purchase of technologies for CCM, hiring of new personnel to handle the program or training existing staff. Even for a robust practice with sufficient resources, the intricacies of CMS regulations can be daunting and the learning curve is steep.
Is outsourcing CCM a much better solution?
Partnering with a third-party CCM vendor provides all-sized practices an opportunity to expand their remote care seamlessly. The right vendor will be able to scale up easily and have the resources to push and cater to larger populations. They will also have regulatory know-how and expertise in preparing billing reports.
True, outsourcing is a full-service investment, but the cost and risk are relatively small compared to insourcing your own CCM program. The revenue from billable CCM services will be substantial, more than enough to cover the additional fee paid to a credible CCM vendor.
After all, getting started with a successful and lucrative CCM program calls for some kind of investment to deliver value-based care to your patients.
If outsourcing is your preferred solution, Ascent Care Partners (ACP) offers turnkey RPM and CCM solutions. There will be no upfront cost, no increasing overhead, no disruptions to office workflows, and no risks. To help you get started with CCM, all you need to do is contact us.
