Despite Uncertainty, Chronic Care Management Initiative Addresses Important Healthcare Gap

We’re all familiar with the high number of adults living with chronic diseases. According to research published by the Centers for Disease Control and Prevention, one in four adults in the United States live with two or more chronic health conditions[i]. Coordinating the care of those patients is challenging for healthcare providers, especially given the short amount of face time doctors get to spend with their patients.

By Lisa R. Esch, Population Health Innovation, CSC

There are a wide number of initiatives designed to improve care of patients with multiple chronic conditions, but support in helping patients navigate their care and make positive lifestyle decisions has been lacking. The Chronic Care Management (CCM) program introduced by Medicare early this year was designed to address this gap.

Under the CCM initiative, Medicare pays healthcare providers an average of $42 per patient per month for non-face-to-face CCM services. But, uptake has been slow. It’s estimated that around 100,000 claims have been billed. That’s 100,000 out of 35 million Medicare beneficiaries who the Center for Medicare and Medicaid Services (CMS) estimates would be eligible.

There are compelling reasons why healthcare organizations have largely failed to take advantage of this program so far, but before we talk about those, we need to discuss the value the initiative offers.

Patient and Caregiver

The primary objective of the CCM is to address well-known gaps in healthcare management and care transitions that lead to serious complications by assisting patients – and their caregivers – to manage chronic illnesses and the associated medical requirements.

The initiative provides care outside the normal provider delivery setting. The purpose is to give advice, guidance, and support to help patients adhere to their care protocols in between visits to their physicians. This includes follow-up calls with the patient to discuss medication management, monitoring care plans, reviewing test results, and liaising with other care providers.

CCM provides particular value to the caregiver because it removes some of the complexity they deal with in coordinating a patient’s care. Most caregivers tend to be either a spouse or adult child of the patient, and caring for their loved one places enormous strain on them since they must keep track of regular appointments, multiple treatments and procedures, as well as other day-to-day care.

Benefit to the Organization

The CCM initiative also benefits healthcare practices and organizations by improving communication and coordination of care for patients, and thereby enabling organizations to differentiate themselves in terms of service provided.

At a financial level, participation in the CCM initiative opens up a new revenue stream for the organization. However, organizations must find ways to scale the initiative and not be weighed down by investments in technology, people and processes to support the program. A business process service (BPS) allows organizations to remove the upfront cost through the provision of a delivery model that can operate efficiently, effectively, and at scale. This is made possible because CCM is, to a large extent, about logistics, so organizations can leverage BPS to manage the logistics and administration of care while retaining full control over care management.

The CCM compensates providers for a service that takes place outside of their normal delivery setting, and that’s unfamiliar territory for a healthcare organization. That’s also exactly why BPS makes perfect sense for CCM, because it’s doesn’t affect a physician’s workflow or create additional workload for the organization – this takes place externally. It’s a model that will require some adjustment for organizations unaccustomed to leveraging partner services around care management, but it has the potential to address the challenges of CCM while delivering the benefits.

Over the coming weeks, we’ll get into more detail on the initiative, including the reasons organizations haven’t yet embraced CCM and how to navigate the complexities.

[i] Multiple Chronic Conditions Among US Adults: A 2012 Update, Ward, BW, et al, 2012, http://www.cdc.gov/pcd/issues/2014/13_0389.htm

Comments

  1. I did not know that there were so many adults that suffer from chronic pains. I like that because of the chronic care management those people that have chronic diseases can get the help they need. Like you explained, because of the challenge that exists for healthcare providers I see how there is such a big need for the chronic care management.

    Like

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