In a 2015 eQHealth blog post, we made the case that “Chronic Care Management is the Future of Healthcare” and a critical component of primary care for Medicare members that would contribute to better health and reduce the growth in expenditures. Now in 2018, after reevaluating the state of healthcare in the United States specifically as it relates to the Medicare population - the future is NOW. Chronic Care Management is here to stay.
Chronic Care Management in 2018
The epidemic of chronic disease in America continues to grow as we speculated in the 2015 blog. There are currently 58 million Medicare beneficiaries in the United States, and two out of three Medicare recipients have multiple chronic conditions equating to nearly $710 billon in gross Medicare spending.
To combat growing healthcare costs and improve care for this patient population, Centers for Medicare and Medicaid Services (CMS) continues to build and improve upon the Chronic Care Management (CCM) Program, CPT Code 99490, they established in 2015. CMS understands that the first effort needs to focus on preventing disease, and once disease is present, providing self-care education - and chronic care management is key to managing chronic conditions.
CCM Program Changes
Leading up to 2018, CMS has made strides to improve the CCM program. They (CMS) listened to the provider community and removed barriers that originally hampered physician participation. CMS also improved payment accuracy for those physicians participating in the program. Additionally, in 2017, CMS broadened the CCM program to include FQHCS and RHCs as well as expanded the scope of care to include specific Chronic Care Management behavioral health codes. (This quick summary is not a complete recount of the improvements to the plan since inception, for more details, click here.)
Chronic Care Management Outlook
A recent research report from Mathematica Policy Research suggests that CMS’s CCM program is moving the cost and quality needle in the right direction. Because of CMS’s invested time and continued expansions of CCM, we believe this program will continue to progress and help contain spending and improve the quality of life for millions. Of course, every situation is different, but where a provider has a large number of Medicare beneficiaries it is highly likely the effort required to implement a comprehensive CCM program using CPT 99490, will make it worth your while. Use this handy calculator to estimate the value of adding a CCM program to your practice.
Check out the infographic below to learn more about why the future is NOW for Chronic Care Management and get on the road or expand your efforts to provide value-based care.