By Thomas Ferry, Engooden Health President and CEO
The Centers for Medicare & Medicaid Services (CMS) 2022 Physician Fee Schedule includes a significant reimbursement increase for chronic care management (CCM). This move indicates CMS understands that CCM services can and do play an essential role in improving patient health, driving down healthcare costs, and improving the quality of life for the millions of Americans living with chronic conditions. The fee change has the potential to impact healthcare programs across the spectrum of fee-for-service and risk-based programs.
Through increased CCM reimbursement, providers gain more substantial incentives to implement programs that extend care beyond traditional clinical settings. Patients in the rising-risk population stand to benefit the most. These patients often cannot or do not access adequate care to prevent their health from deteriorating and preventing them from slipping into the highest-risk territory. High-risk and “healthy” patients also benefit from CCM services, but capturing and addressing the needs of rising-risk patients can prevent a catastrophic health event that would push a patient into a higher-risk category.
What is CCM?
CMS introduced chronic care management in 2015 as a program rewarding providers that extend care to patients with chronic diseases beyond traditional office visits. Patients must have a minimum of two chronic diseases to qualify for CCM, including cancers, depression, diabetes, hypertension, and chronic obstructive pulmonary disease, to name a few. Treating these conditions can be complex, requiring patients to track medications, appointments, therapies, and more. The goal of CCM is to motivate physicians to help patients understand and follow through with treatment.
Under CMS’ chronic care management program, providers must dedicate a minimum of 20 minutes of clinical staff time to chronic care patients every month to receive Medicare reimbursement. Additionally, they must create a comprehensive care plan for each patient, which includes helping patients:
● Manage prescriptions
● Access round-the-clock emergency care
● Establish and meet treatment goals
● Manage community services such as transportation to appointments
● Connect for 20 minutes or more of monthly dedicated CCM services
Better health, lower costs
Research has shown that as recently as 2019, only a fifth of healthcare outcomes are attributed to clinical care. That means the majority of outcomes are driven by factors outside of the traditional clinical setting. It’s no surprise then that high-touch, proactive care such as CCM that gets doctors more involved with patient behaviors can ultimately improve health outcomes and lower treatment costs. For patients in high-risk and rising-risk populations, it’s advantageous as they often have several chronic diseases accessing the amount of care they require.
By moving care outside of the clinic and increasing the frequency of patient-provider interactions, CCM can help avoid adverse health events. It gives doctors a complete picture of patient health, including social determinants of health that often go undetected but significantly impact health. Understanding these factors is vital for delivering more effective care.
Connecting the care spectrum
CCM is using this year’s increased reimbursements to indicate the value of CCM services. Over half of Americans have at least one commonly diagnosed chronic condition, which means every provider has multiple patients who would benefit from CCM. They should take advantage of the new rates by creating a connective care model for their patients, ensuring they get the clinical support and guidance they need between office visits. Care plans drive better patient outcomes, reduce healthcare costs, and increase the quality of life for the many Americans living with chronic conditions.
Too many Americans have developed chronic illnesses due to a lack of education about and reinforcement of healthy behaviors. Regular touchpoints and tailored care plans can help them understand how to create healthier habits and why those behaviors help improve their health. Something as simple as coordinating a ride to a consultation or pharmacy is an essential facet of the care spectrum that helps CCM patients complete treatment.
COVID-19 may have forced many providers to embrace CCM initiatives, but the benefits have been clear. It’s why CMS is providing higher reimbursements and encouraging providers to implement these programs for their patients. CCM means healthier patients and lower care costs, something everyone should be eager to promote.
About the author:
Thomas Ferry is the President and CEO of Engooden Health. Prior to Engooden, for nearly 20 years he was CEO of Curaspan, a discharge planning technology company that he co-founded in 1999 and sold in 2016. Before Curaspan, Thomas held multiple business development roles at American Hearing Centers, Thermo Electron Corporation, and Specialty Chemicals Business, a division of Monsanto.