People living with persistent health concerns or chronic illness, often have more complex healthcare requirements. Implementing a coordinated care model can contribute to better general health and wellness for these individuals.
In 2015, the Center for Medicare Services (CMS) recognized chronic care management as a critical component of care for people living with two or more chronic diseases.
Chronic illness is widespread. Half of all adult Americans have a serious chronic condition – such as arthritis, cancer, diabetes, heart disease, or dementia – and a quarter have two or more. Two-thirds of Medicare beneficiaries have two or more chronic conditions.
Chronic illness is costly. Approximately 85% of all healthcare spending in the United States goes to the treatment of chronic illness. One of the primary drivers of cost, is expensive emergency room care and hospitilizations. An estimated 30% of emergency department visits made by people living with common chronic illnesses are potentially unnecessary, leading to $8.3 billion in additional costs for the industry.*
*The report, released by Premier, found that six common chronic conditions accounted for 60% of 24 million ED visits in 2017; out of that 60%, about a third of those visits—or 4.3 million—were likely preventable and could be treated in a less expensive outpatient setting.
Chronic care management (CCM) is defined as:
Medicare considers patients eligible for chronic care management if they have multiple (two or more) chronic conditions expected to last at least 12 months. Common chronic conditions include, but are not limited to arthritis, ashthma, diabetes, COPD, high blood pressure, and heart disease.
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