Chronic Care Management is a key strategy for healthcare organizations looking to provide better care for patients, better outcomes for high-risk populations, and a lower total cost of care. It was built specifically to address Medicare’s three part aim and has been achieving its goal since it was rolled out in 2015. As the focus continues to shift to a value-based model, CCM becomes an even more important to the strategy of many large healthcare systems, ACO’s and practices. However, despite its proven results, in the face of global nurse and staffing shortages, it is often one of the programs that takes the first hit when resources become scarce.
The truth is, most internally run Chronic Care Management programs never achieve their full potential and resource scarcity is a big factor in that – even in the best of times.
A successful CCM program requires experience, dedication, and resources.
CMS has very specific requirements of the CCM program, in terms of enrollment, delivery, and billing, which can change on an annual basis. Having a dedicated team of compliance specialists to guide the program development is key to ensuring long-term success and compliance. Additionally, delivery of the program requires a team of care managers with specific knowledge and experience. Recruiting, training and retaining people specifically for this role can be very difficult and often takes the back-seat to other roles needed within the organization. The reality is that when care managers work internal to the practice they typically end up covering a smaller percentage of the eligible patients than when those same services are outsourced.
Outsourced services can also bring in best practices and new ideas for enrollment, delivery, and billing that drive continuous improvement and better outcomes.
Two of the critical measures of success of CCM are patient engagement and consistency of care. Both require a steady and reliable drumbeat of communication. An outsourced partner is completely dedicated to the success of the CCM program – from driving patient participation, retention and satisfaction through clinical and financial outcomes. There are no distractions, no reallocation of resources – the care management team is there to succeed. This helps drive a greater % of patients who enroll and it drives more completed events on a monthly basis. That results in better revenue for the practice and better outcomes for the patients, as well as the population as whole.
This dedication to achieving a specific monthly reach rate for enrolled patients is directly responsible for closing care gaps and keeping at-risk patients out of the hospital.
In addition to the dedicated care managers that run the program, CMS requires comprehensive care plans to be delivered to the patients. They are intended to include assessments of the patients physical, mental and social needs, a full assessment of the patients health concerns and issues, goals and outcomes, medication management and coordination of care. A good outsourced CCM vendor will have a library of CMS compliant care plans for their care management team to work from and personalize, ensuring compliance and best-in-class care is delivered in a scalable and consistent way. These care plans must be provided to the patient both when they are developed and any time there is a significant change. The care manager thereby needs a specific infrastructure to deliver this program, including a documentation system and a delivery method.
That requires a lot of upfront work for the organization that is eliminated by utilizing an outsourced vendor.
Whether your organization is planning on keeping their CCM in-house or utilizing a third party vendor, there is no doubt that any CCM program is better than no CCM program at all. However, the benefits of working with an established and proven CCM vendor, like Wellbox, are incontrovertible.
The Wellbox Care Management program is purpose-built to address your high-risk, high-cost populations, close care gaps, and save Medicare money. We document all patient interactions in your EHR ensuring you have the data you need to accurately submit your quality measures to receive the value-based care reimbursements you deserve. We even have a team of specialists on hand who can help you submit to your MACRA MIPS and Star registries.