Preventive and coordinated care programs have been known to produce positive health outcomes, reduced costs, and improve patient care. However, these programs are not able to reach many communities primarily because of insufficient funds or due to the remoteness of their location from their patients.
Why RHCs and FQHCs Should Care About Chronic Care Management?
Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) are examples of those facilities that face challenges when capitalizing on the benefits of coordinated care even though they serve a distinct patient population who can hugely benefit from it.
One coordinated care program that can offer an extra layer of support for RHC and FQHC patients is Chronic Care Management (CCM). CCM enables RHCs and FQHCs to innovate their patient care without draining their existing resources.
How RHCs and FQHCs Use CCM Programs
So how does CCM benefit RHCs and FQHCs? What value does it bring to them?
The Value of CCM to RHCs and FQHCs – Federally Qualified Health Centers (FQHCs) & Rural Health Centers (RHCs)
RHCs and FQHCs can benefit from CCM as they cater to the distinct needs of their patients through regular and remote care.
CCM Fills In The Gap In Care
RHCs often have elderly patients with chronic conditions who may not be able to see their physicians regularly because of the distance they need to travel. FQHCs though found in both rural and urban communities often have their budget stretched to the limit as is the case with RHCs. These facilities are unable to go the extra mile in treating their chronic care patients, who need preventive care to aid them in managing their chronic conditions.
With CCM, RHCs and FQHCs can tap into a distinct care delivery service and solution that enable them to proactively address their patients’ health problems without the risk of increased overhead. CCM provides multiple touchpoints in-between office visits and can be performed outside of the practice by a third-party vendor. This is possible because Medicare allows the service to be performed under general supervision. A CCM vendor can then ease the workload and administrative burdens of the staff to give them more time to care for their patients.
RHCs and FQHCs cater to patients from communities located in designated shortage areas. Both facilities can leverage CCM’s remote care and regular monitoring to fill in the gaps in care. Patients from rural areas with transportation issues can now receive care regularly. FQHC patients can also have access to care that they could not before because of scheduling issues as these urban-located centers usually see so many patients.
CCM enables physicians to stay connected in-between visits so they can keep a close watch on their condition without burdening patients to travel long distances or endure long waiting hours at the clinic.
CCM Eases Workloads
CCM services are more than just the 20 minutes phone call by the care coach to an enrolled patient with two or more chronic conditions. The care coordination activities are quite extensive with most of the CCM work done off the phone. Critical to ensuring the patient’s health status is closely monitored, the care team performs important tasks like clinical documentation, reviews, research, and preparation.
Moreover, the seemingly benign but essential coordination activities include scheduling appointments, finding transportation for visits, managing prescription refills, supporting physicians’ care plans, and answering phone calls at all hours. Meanwhile, the often unnoticed activities cover enrolling and educating patients, sending medication coupons, updating caregiver information, coordinating social determinants of health, and more.
The tedious but essential tasks will be challenging for RHCs and FQHCs without the help of a credible CCM vendor. To illustrate, an RHC patient with transportation problems could choose to miss an appointment but the CCM team can provide the practice with the resources to arrange transportation to ensure the patient sees a doctor.
CCM Assessments Prevent Hospitalization
The CCM care team will perform several assessments that could detect early on a medical concern before it becomes a problem. The results of these assessments will determine what kind of additional help a patient needs. Through this process, the practice is often updated as to their patient’s current health status. Examples of these assessments include cognitive, functional, fall risk, and medication adherence, to just name a few. RHC and FQHC patients who may have fewer visits than expected can still be closely monitored by their doctors with the regular updates provided by the care team.
In addition, CCM can be utilized in risk management, preparing RHCs and FQHCs to be better equipped in reducing risks for their patients. These facilities can capitalize on CCM’s high touch points to identify alarming risk factors to prevent escalation, ER trips, or hospitalization.
CCM Meets Requirements of Grants, Badges, and Recognition
FQHCs can use their grant funds in implementing a CCM program since the service can produce positive health outcomes and bring in new revenues for the practice. CCM can be included under Section 330 Grants under Quality or Technology as well as under the Community Health Center Fund of the practice labeled as “Expanding Services” or “Reaching more Patients.” In addition, FQHCs can obtain more quality improvement badges with CCM, which meets the requirements of different badges.
Both RHCs and FQHCs can obtain their Patient-centered Medical Home (PCMH) recognition because of CCM. With a dedicated care team that can help physicians develop detailed care plans, a practice will be able to meet the requirement of PCMH, whose foundational elements are required by the NCQA to have a Care Management and Support element.
New Income from Reimbursements
In 2016, RHCs and FQHCs were allowed to bill for CCM services bringing in a new revenue stream for both facilities to better care for their patients. For the calendar year 2022 and onwards, CMS has allowed these facilities to bill simultaneously for other care management services like Transitional Care Management (TCM). RHCs and FQHCs can now provide both CCM and TCM for the same patient in the same service period and bill for it.
Because CCM works, adoption has increased significantly with CMS announcing an increase of 50% in reimbursements for the current year. For CPT code G0511 for RHCs and FQHCs, the CCM reimbursement rate is strong with an average of $81.26 for every patient per month. With just 300 enrolled patients, RHC or FHC can have a revenue of $160,000 in just a year.
Moreover, CMS Claims data has shown that patients are now looking for more preventative care visits with E&M encounters increasing by 8%. When a practice sees more patients, this could lead to higher quality scores in their quality numerator results, which means higher payouts. RHCs and FQHCs could use the additional income to hire new staff or invest in further improving their patient care.
CCM Innovates Care
Through CCM, RHCs and FQHCs will be able to innovate their care even with inadequate resources and offer relevant services to their chronic care patients. With the right CCM partner, they can improve their care, reduce the risk for their patients, and avoid the risk of increased overhead.
