Recently, bipartisan legislation was re-introduced to Congress that could significantly change chronic care management (CCM) for the Medicare population. Should it pass, H.R. 4755 would eliminate the cost-sharing responsibilities of CCM services for patients, a factor that has deterred many from seeking the care they need.
CCM helps one in four Medicare beneficiaries across the United States who manage two or more chronic conditions. The practices of CCM not only improve patient health outcomes, but providers have the opportunity to increase their revenue through several forms of reimbursement.
In a recent release by AMGA, after the Centers for Medicare & Medicaid Services (CMS) separated the codes for CCM services in 2015, Medicare beneficiaries became responsible for a 20% coinsurance requirement to receive their medical services, translating to low utilization. Fierce Healthcare also reported that only 684,000 beneficiaries out of 35 million people utilized the services—a minuscule 2%.
Beyond spreading the word on behalf of patients, providers who do not know about this legislation or other updates to the program could miss financial compensation opportunities. Given that H.R. 4755 is endorsed by the American Academy of Family Physicians (AAFP), the American Medical Association (AMA), and the National Association of ACOs (NAACOS), among others, it is an opportune time to discuss two fundamental questions every value-based care organization asks themselves when implementing a CCM program or initiative: where do I begin, and can my staff handle it?
Where do I begin with CCM?
Like all initiatives, an organization lead should first take an in-depth look at their metrics and population demographics. If working with a population health management company, the lead should conduct a substantial discovery process to best understand organizational needs. For example, how many population members actually qualify for CCM? Once that has been determined, how can care managers analyze the mix of patients to determine the level of risk?
Ultimately, the core of transforming CCM processes is expediting the check-in and documentation process so care managers can focus on the patient and not feel the added stress of documentation. This process is more attainable with custom-built assessments formulated to CCM standards and documentation requirements, with room for modifications to meet organizational metrics and objectives.
Does my team have the capacity to handle CCM initiatives, and do I need extra help?
Lightbeam VP of Clinical Transformation, Jessica Scruton, BSN, RN, CCM, stated perfectly in a previous blog post, “creating thoughtful staffing strategies is putting the correct people in place based on the patient population’s needs without over or understaffing to achieve preset goals.”
At Lightbeam, the Clinical Transformation Advisor assigned to a client will use a unique staffing calculator to consider the demands of CCM, the potential engagement of the population, and the relative acuity to determine the correct number of care managers required.
After using the equation, the advisor breaks down the patient-to-care manager ratio further to determine if the organization needs additional CCM professionals on staff. The platform also allows for accurate time tracking and billing code documentation to facilitate proper reimbursement and reporting to scale and grow the program.
The key to the success of any CCM program is engaging the patients that would benefit the most. Then, with the appropriate workforce in place, it is time to decide on the most appropriate recruitment strategies and outreach campaigns.
If they have not done so already, an organization looking to implement successful CCM may need to shop for a population health vendor. Having access to advanced analytics that generate insights from vast amounts of data is critical to managing many patients at once and prioritizing accordingly.
A significant component of effective CCM is medication adherence. Recently, Lightbeam announced its partnership with Surescripts to equip providers with additional tools to make informed decisions on medication management and identify patients at risk for nonadherence and adverse drug events. Read the press release here and learn more about the partnership.
Christine DiNoia, BSN, RN, is Lightbeam’s Director of Clinical Programs.