The healthcare system has long struggled with caring for patients with comorbidities. Analysis of county-level Medicare data from USA Today found that two-thirds of Medicare beneficiaries over the age of 65 have multiple chronic conditions and that the cost of caring for 10,000 of the sickest seniors is around $1 billion.
By Lisa R. Esch, Population Health Innovation, CSC
With this is mind, Medicare introduced the Chronic Care Management (CCM) program. CCM provides reimbursement for non-face-to-face care coordination. The purpose of the initiative is to provide advice, guidance and support that help patients adhere to their care plans in between visits to their physicians.
In my last blog, I spoke about why CCM makes so much sense for patients, their caregivers and healthcare practitioners, but I also alluded to poor uptake of the initiative – recent figures suggest as few as 100,000 claims have been made by practitioners.
There are a number of reasons why adoption has been so low, and it’s important to understand them in order to assess how best to encourage greater uptake for the sake of all parties: payers (in this case Medicare), providers, and above all, patients.
Gap in Understanding
There seems to be some misunderstanding about the CCM program, and that’s probably not surprising. Over the past few years, a large number of programs have been launched with the aim of improving care management. As a result, practitioners may be confusing CCM with accountable care organizations or multipurpose senior service programs (MSSP), which provide social and healthcare management for frail elderly who want to remain independent, or patient-centered medical homes. These are all initiatives that have some form of care coordination.
Related to misunderstanding is the issue of skepticism or program fatigue. Some organizations might view the CCM program as a well-intentioned but potentially complicated program that – handled internally – may well add to their burden rather than detract from it.
To many healthcare practitioners, this is also not a natural way of delivering care since it’s about non-face-to-face coordination outside the normal care setting. This is typically not what healthcare practices have been set up to do.
Furthermore, organizations would have to invest in technology, people and processes to support the program. Among the investments required would be health information exchanges, call centers, and technology to track and document calls. It would necessitate hiring, training and management of staff and being able to scale up and scale down these resources as needed.
For smaller organizations, such investments would be unrealistic, but even for larger organizations it is questionable whether it would make sense to set aside people to focus on this type of care coordination. Take for example a typical internal medicine physician practice looking after 3,200 patients. That population may include 490 CCM qualifying patients requiring 20 minutes per-patient per-month – that equates to at least 164 hours per month per physician.
Realizing the Potential – An Alternative Approach
Yet CCM has the potential to truly move the needle in terms of care for chronically ill patients. It has the potential to keep patients well for longer and reduce the rate of hospital readmissions and so it should not be overlooked. For all the reasons described above, CCM may well not make sense to manage internally; instead there is an opportunity to think in terms of a business process service (BPS). In so doing, healthcare organizations turn to a BPS partner that can provide a delivery model that can operate efficiently, effectively and at scale because it’s designed to service more than one client.
The BPS provider makes the investment and takes the risk in building a delivery capability, but gets the benefit of economies of scale. The physician or provider gets the benefit of guaranteed service level agreement and no upfront cost. Most importantly the patient gets a reliable, consistent and effective service.
CCM is not the traditional model of care and so adopting a new model of delivery with a flexible approach is exactly what is needed to address the challenges facing patients with comorbidities, their healthcare providers and the broader healthcare system.