Today, approximately 117 million people - about half of all adults - suffer from one or more chronic health condition and one in four adults have two or more chronic health conditions, such as asthma, diabetes and congestive heart failure. Although these are some of the most common illnesses among the population today, they are becoming more and more manageable due to preventative measures taken by both physicians and healthcare entities as well as patients.
With the introduction of CPT code 99490 on January 1, 2015, CMS began reimbursing for chronic care management services for qualified Medicare beneficiaries with chronic health conditions that can become more controllable with guidance and close interactions with a dedicated care team. The reimbursement rate for providing these additional care management services is an average of $42 per member per month (PMPM). Many chronic care management programs offer features such as beneficiary medication reconciliation, patient-centered care plans, 24/7 access to care management services, and much more.
While the implementation of these programs is a significant investment, having the right processes in place provides chronic care management programs the potential to deliver significant returns for hospitals, local medical practices, ACOs, and more importantly, additional quality care for Medicare patients.
Tips To Increase ROI And Improve Quality With A Chronic Care Management Program
Chronic care management has also been proven to reduce costs for patient services as well as produce better outcomes for patients. The best ways to improve care, reduce costs and improve ROI with chronic care management are outlined below.
1. Target high-risk Medicare patients
Any Medicare patient that has recently been hospitalized or has a history of being frequently hospitalized may be a good fit for a chronic care management program. These patients will be interested to hear about the services your plan offers, and will most likely want to take action against whatever may be the cause of their frequent hospitalizations. This strategy will take a bit of local research in order to define the leading cause of hospitalizations, including emergency room visits.
2. Create personalized education for each Medicare patient
One of the best services that you can provide for your Medicare patients is education. Many times, patients are anxious about their condition(s). In a world full of complicated medical terminology, many patients will not have a clear understanding of their condition(s) or how they can be managed. By giving these patients simply explained educational materials that focus on their condition(s), they will gain a clearer understanding of these conditions and be able to watch out for symptoms they may cause. The more information they receive about their body’s current state and ways to take care of it after leaving the hospital, the better. When they know more about how to manage their symptoms and take preventative actions, the less likely they are to be readmitted.
3. Utilize one-on-one live interventions with patients
Many types of post-admission interventions can take place with patients, including automated nurse phone calls and electronic communication. However, the most successful form of Medicare patient interventions is one-on-one live communication. Being able to ask questions to medical professionals in person provides patients with immediate answers and valuable information about their condition.
4. Encourage patients to change their home environment
Assessing the home environment of patients who frequently visit the ER (i.e. asthma patients) is important for increasing the ROI of your chronic care management plan. Providing an environment that patients feel comfortable and safe in while still getting the medical treatment they need to manage their symptoms is one of the best ways to keep patients happy and healthy.
Calculating Your Chronic Care Management Revenue Potential
To calculate your revenue potential, take your number of Medicare patients who have two or more chronic conditions and multiply by $42.60 (average national reimbursement per beneficiary). Then multiply that number by 12 months to find your annual revenue potential. Calculate your revenue potential now:
When taking Medicare reimbursement as well as patient service costs into consideration, the potential for great ROI with chronic care management is evident. For more information on how to increase practice revenue with CCM as well as learns the ins and outs of CPT Code 9940, download EQHealth Solution’s free guide.