How is Chronic Care Management Defined?

Chronic care management (CCM) is defined as the the care of patients that have chronic diseases and health conditions. Starting in 2015, Medicare started to pay providers for non-face-to-face care coordination. This enabled physicians to create comprehensive care management plans for patients with chronic diseases.

With CCM patients routinely check in with a clinical staff member. By utilizing a technology platform care administrators and patients can collaborate in the management of their diseases. Chronic diseases are often difficult to manage and often require active management by the patient. In the old model they would generally see their care provider quarterly. With CCM patients have access to clinical staff 24/7.

Why start in 2015?

In 2015 Medicare started paying physicians for a new CPT code 99490. This gave physicians a billing code to create chronic care plans. As healthcare costs continue to increase lawmakers searched for ways to reduce the cost of Medicare. Individuals with multiple chronic health conditions make up a disproportionately large percentage of the health care spending. CCM has the potential to greatly decrease the overall cost of healthcare by providing better care to patients. Many recent studies have found a comprehensive care program to increase outcomes and decrease the cost of care. The Intermountain Health Care Primary Care Medical Home Model was a two year evaluation that found a net reduction in total costs of $640 per patient per year against the control group. The new code provides physicians an incentive to create comprehensive chronic care management programs to help increase patient outcomes and decrease cost.

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Issues with Chronic Care Management

Effectively facilitating chronic care management is difficult as patients are often receiving care from multiple physicians with complex medication and care plans. Providers are often spread between multiple healthcare organizations. The CCM code requires a technology platform to help facilitate the care plan. This allows up to date care plans to be shared with all the patients providers. Using software as the hub of the care plan allows providers to collaborate with each other and the patient. 

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Chronic Care Management Implementation

CCM is being quickly adopted by small practices and hospitals alike. It offers a new recurring stream of revenue for doctors and has the potential to increase patient outcomes. Medicare will pay an average reimbursement of $40+ per patient per month. For doctors and hospitals this can greatly increase the revenue To fulfill the requirements for chronic care management providers need to:

  • Provide at least 20 minutes of clinical staff time must be spent per month with a patient
  • The clinical staff must be directed by a physician or other qualified healthcare professional
  • The patient must have two or more chronic conditions that are expected to last at least 12 months
  • The plan must be comprehensive, implemented, revised, or monitored

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How do you start a CCM Program?

CCM provides an opportunity for providers to increase the quality of their care for patients and increase their revenue from Medicare. The requirements can make it difficult to independently implement a CCM solution. Using a third party can help ensure you are compliant with the CCM regulations. They also offer the ability to augment your team by providing 24/7 access to clinical staff. For more information on how to implement a chronic care management platform see our guide below.