Solutions to Chronic Care Management

Accountable care organizations and value-based programs are constantly seeking cost-effective ways to manage chronically ill patients. Each year, more than 1.7 million people lose their lives to complications from chronic diseases such as diabetes, atrial fibrillation, cardiovascular disease, and cancer, among others. On top of everything, chronic diseases contribute to almost 90 percent of US healthcare costs, according to CMS expenditures. These costs equate to $285 billion in annual spending.

There is no question that chronic care management (CCM) is a necessary part of physician care. Since the launch of Medicare reimbursements for CCM services in 2015, physicians have been working towards complete coordination of this revenue opportunity while improving patient care. Elements of CCM services include 24/7 patient access to care, medication management, and patient data recording with the use of efficient EHR technology.

CCM services also became one of the first opportunities for physicians to be reimbursed for care through non-face-to-face means. In other words, consultations over the phone or through other electronic means have become an integral part of healthcare management for chronically ill patients.

While surveys show that an increasing number of physicians wish to carry out CCM services for their own Medicare patients, a multiplicity of different obstacles and compliance measures prove to be a problem. In addition to providing care, physicians must be familiar with reimbursement and coding practices in order to run a CCM program that is both cost effective and beneficial for patient care.

Up until a few years ago, while physician groups reflected interest in chronic care management, many were prudent in adopting full-fledged CCM service programs.

CMS has since launched annual updates in billing codes, payment rates, and quality provisions of services to simplify and abbreviate qualifications for reimbursement. In an effort to incentivize further participation in CCM services, developments have been made concerning:

• Reduction in reporting requirements to alleviate the administrative burden
• Payment for comprehensive care plan advancements
• Specified billing codes for complex vs non-complex CCM services
• Reimbursement for long-term evaluation and management services via non-face-to-face methods

Organizations who are considering the establishment or improvement of their own CCM services may find lower barriers of entry and planning with these updates. In order to mitigate further barriers in CCM initiation, compliance leaders can utilize additional strategies to facilitate the process.

One method to adopt CCM services can include providing remote CPT code tracking by electronic means on a unified platform. The innovation of robust e-health technology has allowed for the opportunity to simplify CCM operations while furnishing a single point of care for physicians and their patients to review labs, schedule appointments, and review care plans. Platforms such as HealthKOS are appropriate for CCM systems to track requirements and quality measures while enhancing communication between healthcare teams.

Nonetheless, it is important to consider all aspects of implementing CCM programs. Staying up to date with regulatory changes and integrating cost-effective strategies into compliance plans is a surefire way to generate the most value from CCM services. Provider, patient, and service qualifications; coherent policies and procedures; and effective development systems for training eligible teams must be established in order to build a foundation for success and implementation into value-based goals of care and greater healthcare initiatives.