Making Chronic Care Management Work for Your Practice
By Krista Sultan
Having spent the last several years dedicated to helping providers and healthcare organizations align their business practices with value-based payment models, watching 2015 unfold was extremely exciting for me. In January of 2015, HHS announced its most groundbreaking and aggressive plan to transition to new payment models, greatly accelerating the anticipated shift in reimbursement structure. This came in conjunction with the ratification of CPT code 99490, where providers could be reimbursed for non-face-to-face care coordination for the first time. This code can be billed when providers or certified clinical staff spend 20 minutes or more coordinating care for Medicare patients with two or more chronic conditions with an established comprehensive plan of care. The program is formally termed Chronic Care Management, but is more commonly referred to by its acronym, CCM.
While these changes were stimulating for those of us in the industry of facilitating the transition, they were met by reticence and skepticism by many outpatient providers. The initial reaction by so many physicians to CCM was to watch and wait. Despite the fact that programs like this have been successful in many European countries for quite some time, we had not yet seen a US proof of concept. This general consensus was confirmed early this year, when CMS announced that just over 100,000 patients had participated in the CCM program during its first year, and most of those patients only had an average of three CCM encounters.
However, this lack of enthusiasm did nothing to curb the tidal wave of healthcare reform initiatives. We saw MACRA passed into law in April, which actually established a quantitative measure for clinical practice improvement. CMS expanded CCM to include rural health clinics and FQHCs beginning in January of 2016, and then went right back to the drawing board to further expand CCM. The proposed changes for 2017 included additional time and reimbursement for the creation of the initial care plan, a modifier code for encounters that take longer than usual, and an overall relaxation around the enrollment process. The verbiage in these proposed changes also makes it very clear that the priority is around making the program accessible and increasing adoption rather than hunting for imperfections in provider documentation. The central message here is that CCM is here to stay and CMS is heavily invested in making it work.
CMS commitment to CCM is justified in light of the results of a recent patient satisfaction survey that my company, Hello Health, recently completed. Of 100 patient respondents, 86 percent offered a value of “satisfied” or “very satisfied” with the clinical engagement provided by CCM.
We also discovered:
- 90 percent of respondents said they were satisfied/very satisfied with their chronic care coordinator.
- 60 percent of respondents felt their health has already benefitted from receiving CCM monthly calls.
- 78 percent of respondents would recommend CCM to their family and friends.
In other words, patients are finding value in CCM, and measurably benefitting from services that allow them to have a better understanding of their health and care routines. While we look forward to further peer-reviewed support on the inherent clinical value in this program, the initial results are in, and CCM is working. At the end of the day, this is the metric I am proudest of because, if our patients are loving this program and telling us it is making a difference, then I can go to bed at night knowing that we are doing something right. The challenge is now encouraging the broader adoption of CCM, and providing physicians with the resources necessary to offer this program to their patients.
What does this mean for providers considering adopting CCM? Please remember that CCM and other value-based programs do not require all-or-nothing adoption. There are a huge number of vendors available that providers can partner with based on their needs – from consulting services to in-house CCM implementation services, to technology solutions to lighten the workload, to full service solutions that handle everything from enrollment to patient coaching and care coordination.
That being said, for small to mid-sized practices, CCM is a huge undertaking and should not be underestimated. In general, smaller practices simply do not have the resources to set up the program design, finance the additional staff, and stay up to date with evolving regulations while maintaining existing or increasing patient volumes. Furthermore, many providers feel like this process can only be performed by RNs because of the care plan and clinical coordination components. With more and more RNs pursuing bachelor’s degrees in nursing as well as advanced degrees, many practices cannot afford to employ an RN for CCM with an average reimbursement of around $40. However, with proper training and oversight, different types of clinical staff can provide value in this program in a myriad of ways. It’s not necessarily one size fits all with the RN as the sole team member providing services for the patient.
Find the setup that best suits your current workflow and the resources available to you without betraying the core values of your organization that brought your patients to you in the first place. When done right, transitional value-based improvement programs like CCM will strengthen your relationships with patients and empower your staff to feel like they are able to give patients more. After all, improving the value and quality of patient care is really what this is all about.
Krista Sultan is vice president of clinical services at New York City-based Hello Health.