Updated: Jun 18, 2019
In 2017, Centers for Medicare and Medicaid Services (CMS) began to recognize the importance of primary care, especially for those patients with multiple chronic illnesses. Medical care for chronically ill patients represents the most expensive segment of Medicare, with more than 93% of spending going to those with multiple chronic conditions. Additionally, the Centers for Disease Control and Prevention estimates that up to 40% of annual deaths due to chronic illness could’ve been prevented, or at the very least, delayed(see footnote). By introducing Chronic Care Management (CCM), CMS hopes to improve the quality of life of comorbid chronically ill Americans while also reducing costs of treatment.
Actively engaging patients improves compliance of patients. Understanding the results of a test environment – CMS promotes Chronic Care Management, paying physicians to provide a comprehensive telephonic engagement for patients with chronic illness. CMS’ intentions are clear: more communication, better planning, better care and better compliance. If a Physician starts providing CCM services, they are obliged to construct a care plan, communicate with patient on a regular basis, and be available for care and consulting 24/7. Ideally, this program should run smoothly and provide a physician with the necessary information to treat patients in-between visits. However, realistically, between packed schedules in Practice and Hospital, physicians do not have the time to fulfill all the necessary requirements of CCM.
Most physician groups are already at capacity when it comes to juggling regulatory and administrative responsibilities. Currently, doctors must complete CMS programs like the Medicare Access and CHIP Reauthorization Act of 2015, update coding and revenue cycle management, and and maintain day-to-day clinical documentation. Establishing a CCM program is a labor intensive process, typically requiring the recruiting and training of certified staff who will need ongoing training, as well as investment in technology and EHR systems to track care plans and document monthly calls. Additionally, providers need to be available to patients 24/7. Instead of taking on the challenges of creating an in-house program, healthcare providers have the opportunity to pay for assistance with these services.
Rationally, the only way a physician can create a care plan, follow-up with the patient on a semi-regular basis, and still conduct their day-to-day care commitments is by hiring an independent organization with the necessary resources and clinical expertise. Since CMS introduced this program, Case Management companies have integrated CCM care, giving doctors the chance to participate in CCM without a disruption to their normal schedule.
The need for effective chronic care management is growing and will keep on growing with the current health trends. Some estimates (by Rand corporation) shows there will be 171 Million Americans with chronic illness ailments by 2030. Additionally, with value based care model in place, i.e where outcomes and cost is measured, physicians will have no choice but to embrace CCM, no matter their schedules. In the end, Providers must determine if costs associated with hiring and training new staff along with investment in new technology would outweigh vendor costs against potential revenue. And, ultimately, which method would improve patient care the best.
To be clear, although hiring a third-party doesn’t absolve the physician from all requirements of CCM, it does give a provider greater flexibility to serve patient needs and focus on improving quality metrics and patient experience.
All in all, for patients with chronic illnesses(an increasingly larger number of the population), CCM provides a needed supporting hand. Doctors can track a patient’s’ health in between visits, adjusting their care as needed while also diagnosing related potential risks. The result will be better care, less ER visits, and a better connection between patient and doctor. CMS has finally recognized the necessity of CCM. Now, physicians must take the next step.