When implementing chronic care management (CCM) into your practice, it may be challenging to identify which patients are eligible for the service. In 2015, the Center for Medicare Services (CMS) recognized CCM as a critical component of care for people living with two or more chronic diseases. But there is more to the criteria to become a CCM patient than just having multiple chronic conditions. Wellbox, a virtual care provider and market leader in chronic care management, acts as a seamless extension of your practice and makes the process of targeting patients for CCM easy and efficient. By gathering the top metrics to look for in CCM eligibility, we break down your panel for you and identify which patients in your health population will be suitable for CCM solutions.
The process begins with viewing the patient population in its entirety. With the growth and advancement of the U.S. healthcare industry, people are living longer and becoming qualified for Medicare. Currently, there are 44 million beneficiaries enrolled in Medicare, and according to AARP, the numbers are expected to grow as enrollment is estimated to reach 79 million beneficiaries by 2030. As the number of Medicare beneficiaries grows and life expectancy continues to increase, the likelihood for health problems rises as well.
Chronic diseases such as hypertension, diabetes, heart disease, and mental illness are some of the leading health problems in the United States. Many adults who are 65 years and older are afflicted with multiple chronic conditions, making 35% of the total Medicare population eligible for CCM. In total, there are about 15.4 million eligible patients in the United States who need additional support and care for their conditions.
At Wellbox, we work with your practice to identify your eligible patient panel for you.
When reviewing your panel of patients, Wellbox works directly with your practice management system and EHR. We focus on patients your office has seen in the last 12 months and evaluate their eligibility. Once the reports and data are reviewed and analyzed, we generally remove 3% of the total panel for “bad data.”
This typically means removing any data that includes incorrect or missing patient contact information. Studies done by eHI and NextGate have shown that inadequate matching algorithms and poor patient identification have led to patient matching issues. We want to avoid any potential problems and identify the correct populations as accurately as possible, and after eliminating bad data, we are left with a more precise and focused panel.
From this more accurate panel, we begin organizing patients into categories. Patients are sorted by their primary payers, secondary insurances, and chronic conditions. This is to better locate and identify who would most benefit from CCM services.
As many Medicare patients are living on fixed incomes, Wellbox focuses first on the payer category and finds which patients have Medicare Part B. Medicare began paying for CCM services to provide more care coordination to Medicare patients with multiple chronic conditions. When patients have Medicare Part B, Medicare will cover 80% of the associated costs for their CCM services.
Next, with a smaller, but more relevant list of patients, we break it down even further and look for patients who have a secondary payer. Having secondary insurance is not required for CCM services, but Wellbox highly recommends it to help patients cover their fees after deductibles have been met.
From the number of patients that have Medicare Part B, 77% of them will typically also have a secondary payer.
From that panel, 80% of those patients will have two or more chronic conditions. Now we have a full list of eligible patients for CCM from your practice.
CCM is designed to help these patients better manage their conditions. People living with persistent health concerns or chronic illnesses often have more complex healthcare requirements. Applying a coordinated care model like Wellbox’s CCM can contribute to better general health and wellness for these individuals. This includes monthly phone calls with experienced registered nurses who work with patients and their providers through a comprehensive health plan to help them reach their wellness goals. They also provide patients with educational and community resources while sharing information about the encounters directly into your practice’s EHR, ensuring full transparency and visibility.
Implementing chronic care management and finding eligible patients doesn’t have to be difficult. When you partner with Wellbox, we make it easy for your practice by handling CCM from start to finish. We find the most qualified patients in your panel and break down the CCM criteria to easily identify patient eligibility. From there, we enroll your patients, provide the service and bill Medicare for CCM directly. If leveraging Wellbox’s end-to-end chronic care management solution sounds like something that can work well for your practice and patients, our team can help set it up for you. Contact us today to get started.
Discover how Chronic Care Management is driving significant clinical and financial outcomes for high-risk, high-cost Medicare populations in this whitepaper.