In January 2015, the Center for Medicare and Medicaid Services (CMS) approved monthly chronic care management reimbursements for healthcare providers. This is opening up a new opportunity for patients to receive better quality of care and reduced healthcare spending. So that you can take advantage of these services, we’ll answer the questions, what is chronic care management, why is it important, and who is it for.
A chronic disease is a long-lasting condition that can be controlled but cannot usually be cured. Examples include: diabetes, depression, COPD, Ischemic heart disease, heart failure, hypertension, chronic kidney disease, cataracts, anemia, arthritis, obesity, Alzheimer’s disease, dementia, asthma, atrial fibrillation, cancer and osteoporosis.
There are many reasons why chronic care management has become important. According to the Centers for Disease Control and Prevention, about half of the American population had one or more chronic diseases as of 2012 and seven of the top ten causes of death were due to chronic disease. This is costing us not only our health and our quality of life but also extra healthcare expenses. In 2010, 86% of all healthcare spending was for people with one or more chronic medical conditions, and two thirds of Medicare dollars are spent on patients with two or more chronic diseases. In addition,10,000 baby boomers, whom are prone to multiple chronic diseases, will turn 65 each day through 2029.
Chronic care management is a model of care that involves coordinating and managing your care in between doctor visits in order to improve patient quality of life, strengthen patient engagement, and reduce healthcare costs and complications. It is one of the first steps Medicare is taking to shift away from fee-for-service care to value-based care.
The overall goal of chronic care management is to ensure you get the best care possible from everyone involved in your care and that you know how to manage your care in between visits. It includes the creation of a comprehensive care plan as well as coaching the patient to stay accountable in engaging with the care plan. It also includes 24/7 phone access to care coordinators. Your care coordinator is there to talk to you on the phone about your symptoms, help manage medications, and to help coordinate visits with doctors, labs, radiology, and other testing facilities and providers.
Benefits of chronic care management include:
In order for your provider to bill Medicare for your chronic care management services, they must provide the following services to you:
To receive Medicare coverage for chronic care management, you must have two or more chronic conditions expected to last at least 12 months or chronic conditions that place you at significant risk of death or acute exacerbation/decompensation. The coverage is for non-face-to-face care management.
Care management is now recognized as a critical component of primary care because it drives improved outcomes for population health and serves as the foundation of population health management initiatives. It has been demonstrated that better outcomes come out of a team of care providers giving a patient more consistent care, especially for high risk and rising-risk populations. This is because each provider in the care team works together to enable interventions at appropriate times and the addition of a care coordinator ensures that gaps in care are closed.
Providers didn’t used to be reimbursed for between-visit care. Until Medicare put these reimbursements in place, patients were left to coordinate their own care between visits, which ends up creating gaps in patient-provider communication and leads to fragmented health data, duplicate tests, increased healthcare expenses, and a higher likelihood of poor health outcomes.
Patient engagement is the key to obtaining wellness because it is the patient’s lifestyle choices that have the most effect on their health outcomes. Care management engages patients and gets them participating in their health with the accountability they need to follow through. This leads to smoother recovery from health episodes and promotes ongoing self-management of health.