What’s Holding Large Practices Back from Committing to CCM? Seeing Opportunity vs. Disruption

Despite the potential benefits of improving overall patient care and the incentives offered, the CMS initiative for patients with multiple chronic conditions – chronic care management (CCM) – has so far not won over many large physician practices.

By Lisa R. Esch, Chief Population Health Innovation Officer, CSC

Healthcare providers are, of course, well aware of the huge cost of managing patients with several chronic conditions, not only in terms of the pressure on Medicare spending but equally on the health of patients. When implemented, CCM has the potential to improve management of patient health, eliminate unnecessary costs and help physician practices get ahead in the new value-based care environment.

For CCM to have any impact on the management of a practice’s at-risk Medicare patients, it has to be implemented at scale. If only a very few patients in a practice sign up, the program won’t succeed in improving the quality of care at a population level, and will end up costing the practice.

Practices experience significant challenges around the time, resources and infrastructure needed to support such a program at scale.

Time is Money

At the most practical level, practices need to determine how to manage the recording requirements to demonstrate to CMS that the practice has, in fact, committed the required time to patients. The truth is, most primary care practices are already engaging in non-face-to-face time checking in with high-risk patients without realizing it, let alone documenting it or billing for it, as it was previously not possible. Nationally speaking, millions of hours spent on care coordination continues to go unbilled.

Dr. Robert Wergin, president of the American Academy of Family Physicians, for example, estimated he would typically spend two hours a day reaching out to elderly patients living in rural Milford, Nebraska. Most patients in that age group, have a difficult time visiting the office and “quite honestly, I just didn’t get paid for it,” Wergin explained.

Resource Pressures

The more complex hurdle is coordinating all the care that surrounds the patient to encompass their entire care journey. Practices would require a dedicated and trained staff to manage the patient support.

A large practice with 10,000 or 20,000 Medicare patients would, therefore, have to hire a lot of clinical employees to provide 20 minutes of coordinated care to each patient and meet the CCM scope: recording the patient’s health information, devising an electronic care plan, ensuring access to care management services, managing care transitions, and coordinating and sharing the patient’s health information with all their care providers.

That is an enormous commitment for any practice and most physicians I’ve talked to say it’s disruptive to the practice and not worth the amount they will get paid by CMS to manage the program at scale.

Building the Infrastructure

There is, perhaps, a gap in understanding about the longer-term benefits of CCM. It’s not just about improving the care of patients; it’s about building the infrastructure to manage patients when they’re not in the office: hiring and training the right staff, dedicating resources to the process and making it all seamless. Once you achieve that breakthrough the result is improvement in quality, better patient engagement – including with the practice – and reducing the cost of delivering care for patients who are being managed outside a physician visit.

Luckily, CMS recognizes the need for both – the time chronic patients require and the support system practices need to have in place to enable that sort of high-touch connectivity. With that in mind, CMS allows outsourcing to qualified experts, removing the need to build that infrastructure while ensuring the practice is on the right path to achieving value-based care. Working with a partner who is experienced with handling coordinated care removes the need to hire staff internally and disrupt the practice. While the physician educates their patients about the program, a CCM partner removes the staffing burden while ensuring the physician practice stays compliant with the program.

CMS recently announced plans to soften stringent billing requirements around CCM. With more than 50 million chronically ill patients in need of consistent interaction and just a small percentage that are currently enrolled, there is a significant push to motivate practices and providers to participate.

While CCM has the potential to be a disruption to a large, busy practice, it doesn’t have to be. It can be a valuable tool for improving the care of patients and ensuring proactive engagement by having a solid partner and, therefore, infrastructure in place.



  1. […] What’s Holding Large Practices Back from Committing to CCM? Seeing Opportunity vs. Disruption […]


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