Blog

April 18, 2016 | What the Value of the CCM Copay Means for Patients

Every month, telehealth and Medicare’s chronic care management (CCM) program are gaining popularity among patients whose needs extend beyond the doctor’s office. It’s now well-documented that patients with chronic conditions benefit by speaking with clinical experts. They discuss how they are progressing with their treatment programs and if they are experiencing any on-going challenges with care. However, there are still barriers preventing all eligible patients from receiving this service. One recurring issue that may affect a patient’s decision to enroll in CCM is the monthly copays. Each telehealth call currently has a copay of approximately $8 per month.

Physicians might assume it makes sense for patients to want to participate in CCM due to the perceived low copay. But patients could feel that for $8 a month they will not receive the same level of care as they would from in-person consultations. However, compared to the total cost of care related to hospitalizations, preventative care ensured by this copay becomes the more logical choice.

Consider this: The average copay for an emergency room visit is $100. Depending on their reason for the visit, the issue may have been solved by a quick telehealth phone call. It would save the patient the cost of admittance as well as convenience for immobile patients. When comparing the price of telehealth and emergency room visit copays, outside costs also need to be considered. If needed, the cost of an ambulance ride could amount to around eight hundred dollars on top of the existing ER copay.

By itself, a total of $96 per year may seem like a high cost to receive “phone calls.” When compared to the possible prices associated with an ER visit, these telehealth calls are not just convenient, but necessary.

Anthem, the nation’s second-largest insurer, offers no copay for regular monthly telehealth calls. Even though more insurance companies are allowing their plans to cover telehealth services, many insurers still do not. As such, Medicare’s CCM is offering one of the most cost-effective and affordable telehealth options on the market today. It is quickly proving to be a great example of what these programs should look like in the move to value-based care.

No matter how convenient these monthly calls are, some Medicare patients may simply decide not to join due to the eight dollars. Whether or not they have additional income sources, some elderly individuals just don’t have the money for a monthly copay. Others prefer to visit their primary care physicians on a monthly basis or don’t believe that they will benefit from the calls. However, recent reports show that Medicare is now working to drop the copay entirely. This could presumably increase patient interest and help reach a greater population of at-risk individuals.

No matter how you slice it, telehealth and CCM enable patients to avoid frequent and costly office and ED visits. It also helps keep them on top of having better control of their own health with a small monthly copay. It sounds like a win-win to us.