How to Get a Chronic Care Management Program Started Fast

by John Zulaski, President, Practice Management

Practice Management is a participating partner in the Center for Medicare and Medicaid Services (CMS) Connected Care program, promoting the value and benefits of Chronic Care Management (CCM) services. We seek to help bring providers and patients a valuable service. Providers engaging CCM services benefit from significant financial incentives, improved outcomes, and the potential to reduce administrative burdens. Patients benefit through consistent contact with the care team directing them to needed resources such as their healthcare provider and to direct them away from harm.

As the challenge of providing these additional services in-house has been examined, a strong need for assistance has been identified by many companies specializing in CCM. Challenges include hiring and managing productivity. The biggest challenge is to meet the 20 minute requirement for 90% or more of enrolled patients.

The outsourced CCM is an elegant solution that is being rapidly adopted by healthcare providers large and small.  Most companies offer a software solution or a fully staffed CCM team. While many provider organizations feel the best solution is to perform the task in-house, the delay while building and training the CCM team may be costly. Delay means months going by with no service performed, and no revenue. A viable plan that doesn’t leave money on the table might be to start with the full service option and transition to in-house at a comfortable pace.

Costs of these services range from 50-65% of the per patient per month reimbursement with the remainder left as practice profit. Once the program is up and running, there is very little for provider offices to do except to help patients enroll (generally by verbal consent). The financial impact can be substantial given that most Medicare patients meet the requirement of two chronic conditions. A practice with just 10,000 Medicare patients participating monthly (and only performing the basic 20 minute service) would see $140,000 to $200,000 per month after paying the outside CCM service. That’s $1,680,000 to $2,400,000 per year!

CMS continues to roll back barriers to participation in an effort to invest in the savings that CCM is expected to generate. Could CCM benefit your patients?