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What are the benefits of Chronic Care Management?
Although it offers different advantages to different parties in different ways, the essential benefits of Chronic Care Management are better patient engagement, outcomes and access to care, and lower costs for providers and payers.
But each of these CCM benefits is also interconnected, and getting the best possible results requires a strategic approach to each. Let’s take a closer look.
Looking for more info on CCM? Get a full definition of Chronic Care Management here
Benefit #1: Recurring reimbursement opportunities
Defined as the management of a patient with two or more chronic conditions, the Chronic Care Management program offers eligible healthcare providers specific amounts of reimbursement for time spent on the following tasks:
- Patient assessment and care planning, including management of care transitions
- Communications between the patient and physician or clinical staff, including non–face-to-face interactions like video visits or phone calls
- Patient coordination, such as arranging follow-up appointments, refilling prescriptions, and requesting and updating medical records
Reimbursement for these activities is available with the use of CPT® billing codes 99490, 99491, 99487 and 99489 and/or HCPCS code G0506 by eligible practitioners. This includes physicians or qualified health care professionals (QHPs) like a physician assistant (PA), nurse practitioner (NP), clinical nurse specialist (CNS) or certified nurse midwife.
In some instances, a billing practitioner can be a nurse, therapist or other clinical staff member operating under the direction of the doctor or QHP. Reimbursement amounts will vary depending on a patient’s physical location, as well as whether they require complex case management. See our guide to CCM codes for more details, as well as current reimbursement amounts.
Benefit #2: Reduced utilization costs
The list of chronic diseases is a long one, and includes many of the country’s deadliest conditions, such as cancer, chronic obstructive pulmonary disease (COPD), congestive heart failure, heart disease and cardiovascular disease, hypertension, coronary artery disease, diabetes, stroke, Alzheimer’s disease, chronic kidney disease, depression and many others.
It should come as little surprise, then, that managing all of these chronic conditions makes up as much as 86% of all U.S. healthcare spending. Chronic Care Management can help bring these costs down by offering more preventive-oriented care to reduce hospital admissions and other costly and preventable forms of utilization. And this is a benefit of chronic care management that will only expand in value as the population continues to trend older, and the prevalence of chronic conditions rises.
Benefit #3: New revenue streams
Chronic Care Management can help organizations generate additional revenue in a number of ways. In addition to reducing utilization and capturing additional reimbursement with CCM billing codes, a robust Chronic Care Management program can also enable the treatment of a larger number of patients or residents. It can also help to ensure that each one gets the screenings, tests and procedures they need at the recommended time.
The result can be greater revenue per patient per month, as well as a chance to improve patient satisfaction with better care and outcomes — and that in turn can boost referrals, further fueling growth. Best of all, this can all be done with fewer staff members, thanks to the improved workflows that come from adopting remote patient monitoring technology.
Benefit #4: Enhanced care coordination
The difficulty of coordinating care among every appropriate member of the care team has long been an obstacle to the effective treatment of chronic conditions. From the physician serving as primary care provider to QHPs, specialists, nurses, aides, social workers and more, the CCM model encourages greater cross-team coordination by requiring it for reimbursement. And the use of telehealth technology enables the immediate delivery of that communication, at every point along the care continuum.
Benefit #5: Improved outcomes
Improved care coordination doesn’t just improve workflows but actual health outcomes, too. By better connecting everyone involved in patient care, and by offering actionable, real-time clinical data and intelligence, CCM can ensure more informed decision making and earlier interventions. And that can reduce risk of deterioration, acute exacerbation and hospitalization for patients with a chronic care diagnosis, while also offering them a better quality of life.
Benefit #6: Greater productivity and a more positive culture
Making it easier to manage chronic care patients also makes life better for clinical workers. By offering easier data collection, more effective patient communication and the chance to work remotely, CCM programs can improve job satisfaction for nurses and other essential workers. And that could help improve staff retention at a time when that’s never been more important, particularly for skilled nursing and long-term care facilities continues to face severe worker shortages.
Benefit #7: More engaged patients
Almost 80 percent of adults aged 50 and over “say they want to remain in their communities and homes as they age,” according to a survey from the AARP. Chronic Care Management is designed to enable seniors with chronic conditions to do exactly that. It also enables greater communication, helping them to feel heard and understood, thus improving their sense of connection and engagement.
In addition to the benefit of receiving care in the comfort of their own homes, the greater interaction enabled by CCM also helps patients feel invested in their treatment plan, keeping a closer watch on their own vital signs than they normally would. This new level of engagement can lead to improved satisfaction, and helps providers keep their patients safe, healthy and out of the hospital.
Benefit #8: Better access to care
Because it’s designed to be delivered remotely, the benefits of Chronic Care Management aren’t restricted to patients within driving distance of a facility, but available across an entire region. This is determined by local and federal regulation, which will vary based on the exact location of each patient and provider. But restrictions around this have loosened, especially during the ongoing Covid-19 Public Health Emergency (PHE). (Stay tuned to the CareSimple blog for updates.)
So, organizations that embrace the CCM model could expand their patient base, without the need to significantly raise their staffing levels. For skilled nursing organizations, that could mean a chance to move into home care — another way to help offset the shortage of workers.
In addition, researchers have pointed out that “inequities in access to health care” can also be defined as “lack of cultural competence of health-care providers.” Chronic Care Management helps overcome this obstacle by connecting patients with providers who better represent them. Because it leverages the power of remote care technology, CCM can put patients in easy contact with a specialist that best matches their needs, even if they’re based in a facility several states away.
Find your Chronic Care Management (CCM) solution with CareSimple
At CareSimple, our virtual care platform is designed to meet a variety of needs — including delivering the benefits of both remote patient monitoring and chronic care management. Contact us today to see how we can put our expertise to work for your organization.
And if you’re looking for a full rundown of reimbursement codes for CCM and other models of care, download our CareSimple Reimbursement Tree for a handy, single-page summary.