Added September 12, 2018

Care coordination can increase per physician revenue by 20% overnight through additional reimbursements coming from chronic care management (CCM) CPT codes. Chronic care management (CCM) is the process of managing care for patients who have two or more chronic conditions and can benefit patients regardless of age, gender, or disease type.

Starting in 2017, Medicare has stepped up their support for managing chronic conditions. This is a smart move for Medicare. According to the Agency for Healthcare Research and Quality (AHRQ), patients who have two or more chronic conditions cost an average of seven times more than patients with a single chronic condition. With approximately 20% of the total patient population in the United States on Medicare, managing chronic conditions can influence millions of covered lives across the country.

The focus of the new chronic care management (CCM) reimbursements is to ensure patients with chronic conditions are getting the support they need outside of the care facility. It is outside of the care facility, at the patient’s home and away from the patient’s care provider, that treatment beings to fall apart and where the patient no longer adopts care.

Medicare has found if there is communication and follow-up between the care provider and the chronic patient outside the care facility, in-between visits and after discharge, the percent of complications steeply decline. For this reason, they are reimbursing care providers an average of $43.66 for every 20 minutes of chronic care management within a month’s time-period. This additional reimbursement can add up and improve per physician revenues by more than 20%.

To achieve this added revenue, care providers must look at care coordination. Care coordination is the process of using an individual called a care coordinator to direct the care of the patient before, during, and aftercare. This can include the care coordinator connecting the dots for each member of the patient’s care team across the care continuum from primary care to specialty care. It would include having the care coordinator assist the patient with other often neglected services like mental health and physical therapy.

The goal of the care coordinator is to keep the patient engaged in their care in a way that manages the chronic condition. This will keep care management at the top of the patient’s mind preventing avoidable complications. To create lasting results, the care coordinator should consider the entire patient including their physical and mental wellbeing as well as what motivates the patient. By doing so, they can create care plans and patient approaches that are tailored to individual patients.

Care coordinators can be in-house employed at the care facility or contracted out through remote on-demand services like CareAssist. The benefit of remote on-demand care coordination services like CareAssist is that care providers do not need to worry about additional employee headcount. However, they benefit from additional reimbursements and higher quality of care. Regardless of the method of employing care coordinators, care coordinators are the linchpin in making chronic care management care coordination work. Healthcare organizations who prioritize chronic care management will find care coordination produces the best output for achieving their clinical and financial goals.