Chronic Care Management (CCM) is a Key Constituent of ‘Virtual Health’ Enabling Patient-Centric Care
Chronic Care Management (CCM) is a key constituent of ‘Virtual Health’ enabling Patient-Centric Care. CCM is a catalyst in reducing costs across healthcare systems. CCM also increases the revenues of practices at $44 per patient per month.
Over 90% of all healthcare spend goes toward treating people with chronic conditions.
Improving health leads to prevention of secondary complications, reduction in emergency room visits, hospitalizations, and readmissions.
CCM is a proven option that helps manage patients with chronic ailments between office visits.
Half of all patients readmitted to hospitals within 30 days had no or minimal post-discharge contact with healthcare professionals. Patients with multiple Chronic Conditions have better outcomes when they are given tools to promote better self-care and have a skilled resource to help coordinate care between multiple providers.
Patients receive better continuity of care when a practice develops a holistic view of patient’s needs related to functional, social, physical, and mental health and provide a point of regular contact for the patient. CCM addresses this gap in care by managing patients between office visits.
Chronic Care Management assists in care coordination by:
Engage in monthly patient contact
Communicate, engage and monitor patients by clinical staff
Encourage patients to follow physician-approved care plan
Discuss, direct and assist Patients with socio-economic requirements
Periodic Medication Reconciliation, assistance with refill requirements; review of adherence and interactions; document any OTC medication consumed
24x7 access to clinical staff
Schedule appointments for follow up visits
Greater vigilance by patients with chronic conditions is not difficult and can be a key to healthier outcomes with lower costs. In addition, these “care beyond the walls” programs prevent complications and costly interventions.
CCM Eligible Chronic Conditions:
There are over 50 chronic conditions that are eligible for CCM Services.
Addiction/substance abuse Alcoholism Opiate abuse
Autoimmune diseases Osteoarthritis Rheumatoid arthritis
Blood disorders Anemia Leukemia
Cancer Breast cancer Colorectal cancer Prostate cancer
Cardio-metabolic conditions Congestive heart failure Diabetes Dyslipidemia
Chronic pain Resulting from diseases in various therapeutic areas, e.g., autoimmune diseases, cancer
Endocrine disorders Addison’s disease Hypothyroidism
Eye conditions Cataract Glaucoma
Gastrointestinal diseases Crohn’s disease Gastroesophageal reflux disease
Infectious diseases Hepatitis C HIV
Kidney diseases Chronic kidney disease End-stage renal disease
Lung diseases Asthma Chronic obstructive pulmonary disease Emphysema
Mental disorders Bipolar disorder Depression
Neurological diseases Alzheimer’s disease Multiple sclerosis
Urologic diseases Benign prostatic hyperplasia, Interstitial Cystitis