Chronic Care Management Overview

Important Statistics for Chronic Care Management

With the start of 2012, about 50% of all adults —117 million individuals—had chronic health conditions. One out of every four had at least two chronic health conditions.

As indicated by a report from the Congressional Research Service, the percentage of the population aged 65+ will grow from 12.4% in 2000 to 17.9% in 2025 and 20.2% by 2050. This is meaningful because the likelihood of having multiple chronic conditions significantly increases with older age: nearly 50% of the U.S. population aged 45-64 and 80% of those aged 65+ have multiple chronic conditions. [Source: Catalyst]

U.S. Population, by Age

Chronic Care Management Value Proposition

The tangible benefit of CCM is to aid patients with chronic conditions better manage their self-care and optimize their health, while reducing unnecessary utilization of health services and reduce associated costs. Moreover, proper management of chronic conditions can enhance patients’ lives tremendously; diminish complications; alleviate costly methods, reduce emergency room visits, hospitalizations, and readmissions; and reinforce Patient Engagement.

From the patient’s perspective, CCM programs are more reliable and beneficial for their care plan and give 24/7 access to care.

The shift from Fee-for-Service to Value Based Care

In the past, Healthcare providers were reimbursed under a Fee-for-Service (“FFS”) structure, which counted towards volume rather than value. They were repaid for the number and quantity of patient visits, medication orders and prescriptions and tests required.

The Affordable Care Act (“ACA”) of 2010 and the Medicare Access and CHIP Reauthorization Act (“MACRA”) of 2015 initiated a steady change in how healthcare services are reimbursed , far from FFS and more towards Value Based Care (“VBC”).

In January 2015, Medicare began a new program called Chronic Care Management (CCM) and established a new billing code for it – 99490, that pays Providers $41 every month for giving no less than 20 minutes of non-face-to-face care to Medicare patients with at least two chronic conditions (“Medicare CCM”).

Outsourcing CCM, the perfect solution for the masses

Detailed documentation prerequisites required from Providers and Payers has always been important for coding and billing, but is critical in order to obtain and qualify for Medicare CCM reimbursement. Healthcare Providers must provide extra documentation, effectively and precisely for reimbursement and adhere to strict due dates – all of which are a burden plus money and time consuming, especially when faced with a limited labor supply and high opportunity costs.

Healthcare Providers look for outsourced solutions to handle the extensive documentation process that is expected to quantify results, patient information, procedures and accompanying results that payers require and analyze. All this plus creating a new, significant revenue stream for the practice. This is entirely possible, even for smaller practices, when Chronic Care Management coordination is outsourced to a healthcare organization that specializes in this type of service.

Outsourced solutions effectively diminish existing clinical staff expenses and thus result in clear and guaranteed ROI.