A new study shows that a government program for managing chronic conditions cuts costs and improves care.
In January 2015, the Centers for Medicare & Medicaid Services (CMS) introduced a separately billable non-face-to-face Chronic Care Management (CCM) service. The goal is to improve Medicare beneficiaries’ access to chronic care management in primary care. These CCM services provide support for patients with multiple chronic conditions in-between their provider visits and episodes of care. The program also provides new “in-between visit” payments to participating providers. That revenue encourages healthcare providers to focus more on goal-directed, person-centered care planning, and provide “aging-in-place” resources such as proactive care management, the report explains.
Over 684,000 beneficiaries received CCM services during the first two years of the new payment policy. Providers billed for 3,513,179 claims for CCM services for a total of $105.8 million in fees.
Interviews with 71 eligible professionals (or their specialty societies) revealed that providers and care managers perceived several positive outcomes for beneficiaries from CCM including: improved patient satisfaction and adherence to recommended therapies, improved clinician efficiency, and decreased hospitalizations and emergency department (ED) visits. Most noted patients’ enhanced access to the practice through the care manager, which enabled telephonic condition monitoring between visits and more time for medication monitoring and reconciliation.
Providers with whom we spoke reported that the CCM payment helped them better support staff who connected patients to home and community based services. Thus, it is not surprising that engaging CCM beneficiaries would increase use of community-based services, such as home health, because of increased care management, concomitant recognition of patients’ formerly unmet needs, and the potential desire to reduce acute care utilization.
We also found evidence that CCM was more effective at reducing Medicare expenditures among beneficiaries who died during the follow-up period suggesting better management of end- of-life care.
CCM practices’ scope of service
The CCM scope of services requires participating providers to: create a patient-centered care plan that is shared with the beneficiary and his/her other providers; provide care continuity, enhanced opportunities for communication with the practice and timely access to needed care, and; provide comprehensive care management, including medication review and coordination of care with specialists and during care transitions.
How beneficiaries felt about their doctor’s office approaching them about CCM services
Beneficiaries most commonly learned about CCM services from their primary care physician, or another member of their primary care team, such as a nurse practitioner.
When asked about their first impressions, many beneficiaries reported positive reactions to the discussion about CCM services, and felt the conversation reflected the provider’s commitment to their well-being. Some beneficiaries said they were glad their doctor was getting paid for time spent communicating with them outside of regular office hours. Others liked the idea of not having to wait until their next office visit to share concerns that came up along the way. As one beneficiary noted,
“I thought it was a pretty good process to stay on top of my health.”
Many of the beneficiaries who thought CCM sounded like a good idea mentioned new or ongoing health problems that had become a growing concern, and they felt they could benefit from more regular communication with their practice. As one beneficiary explained,
“I felt, at that point, that it was to my advantage for them to be able to coordinate between different doctors for senior care.”
“It sounded like a good idea to have somebody else in there that you could call and talk to and ask questions and then she would find the answer and get back to us.”
Care continuity, coordination and communication
Many patients noted enhanced communication with their practice since signing up for CCM, typically by phone calls to them by a nurse, care manager or other provider. Some patients noted that their practice also made sure it was the same person who contacted the patient between appointments to check in and address any ongoing health concerns. One beneficiary expressed his appreciation of that continuity, saying
“You’re talking to the same person every time. It’s somebody that knows my history, knows my medications, knows the doctors I’m seeing, knows what I’m being treated for.”
Patients also noted being given the opportunity to note their preference for mode of communication (e.g., phone, secure email). Several beneficiaries reported that CCM services had improved coordination across their care team. As one beneficiary stated,
“I see so many different doctors. The main thing is to keep everybody on the same track. Everybody knows that they have to send everything that I have done at their office to my primary doctor so that they know what’s been going on with me, and they don’t have to sit and call around and ask for lab work or test results.”
“Sometimes things that happen to you, where you’re seeing a specialist or you’re having this checked, sometimes you have a tendency to forget something that was pretty important for (the primary care provider) to know in your care going forward…this was a way to keep them involved in my total care, whether they were administering it or somebody else was administering it.”
Timely access to care
Many beneficiaries felt that participating in CCM services had provided them with more timely access to their CCM practice. Beneficiaries appreciated having ready access to a nurse or care manager who could communicate with the physician or schedule an appointment more quickly than the patient could have. As one beneficiary explained,
“I felt like I had an in to the doctor, like there was somebody else to help me through that process [rather] than just calling the main number and then you wait on hold and then they have to type it in the computer and then they have to get it to the doctor.”
Another described how prompt attention from her primary care office helped prevent a potentially dangerous drug interaction,
“When I had a blood test, my iron was low, so the doctor said that I should go to the drugstore and buy some iron medicine. (…) I was just looking at it one day and it said on there do not take iron medicine with the thyroid medicine, that it could have serious repercussions. I called (the nurse) and asked her… Within five minutes, she had talked to the doctor and he had given her different instructions and she relayed it to me and we changed the medicine and it was all done like in 15 minutes.”
A small number of beneficiaries, who previously had concerns about taking up too much of their doctors’ time, reported feeling more comfortable calling the office with a question or concern, knowing that there was someone available who could respond promptly, and could put them in touch with the doctor if the situation merited that kind of attention.
Care management benefits
Beneficiaries generally appreciated the monthly check-ins and described them as “reassuring” and “a good reminder.” One beneficiary described how the monthly phone calls helped him and his wife, who was also receiving CCM services, to remain mindful of their health,
“We think about our health more and what we’re doing right or wrong with these phone calls that we’re getting every month now. It’s a good thing.”
Another beneficiary described how having more regular communication with his provider – influenced him to continue taking his medications despite some undesirable side effects,
“For one thing, I think I’m more conscious of taking my medication. …Being in constant contact with him, you begin to realize, look, yes, it’s going to have some side effects here and there, but its doing what it’s supposed to do.”
Other beneficiaries described additional benefits of the regular check-ins,
“They call when it’s convenient for me to chat. If I can’t immediately, they ask questions if there’s anything I need, boom, I get a quick, rapid response from the doctor’s office.”
Several beneficiaries felt that receiving regular calls from the practice spared them unnecessary visits to the office, and freed the doctor from spending time on questions or problems that a nurse or care coordinator could address. One explained,
“I’ve got a lot of different physical problems, and having somebody coordinating them, it’s easier to do with the nurse practitioner and less expensive for me than to try and do it with an internist. It’s simply the sort of thing that a professional without an MD’s training is perfectly capable of doing. It’s useful to be able to speak to somebody monthly about ongoing problems or something new that has come up.”
Many beneficiaries felt CCM services were beneficial and planned to continue participating. A beneficiary, representing the opinion of many, said:
“I’ll continue to participate until my heart stops beating.”
During the past five years, CMS has made a strong commitment to supporting primary care and has increasingly recognized care management as an important component of primary care. It contributes to improved health for beneficiaries and reduced expenditure growth.
Participation in the CCM program was associated with a lower growth in total costs to Medicare than the comparison group. Patients in the CCM program had lower hospital, emergency department and skilled nursing facility costs., along with a reduced likelihood of hospital admission for the ambulatory care sensitive conditions of diabetes, congestive heart failure, urinary tract infection, and pneumonia. The study concluded that “CCM is having a positive effect on lowering the growth in Medicare expenditures on those that received CCM services.”
Interviews with 71 eligible professionals revealed that providers and care managers perceived several positive outcomes for beneficiaries from CCM. They included improved patient satisfaction and adherence to recommended therapies, improved clinician efficiency, and decreased hospitalizations and emergency department visits.
Clearly, this new program is a win for the patients, providers, and the payers. But for many provider organizations, the study shows the reimbursements are inadequate to support the costs associated with providing these new services.
Here’s where we can help. We already have the infrastructure (people, process and technology) in place. Partnering with Vigilance Health will enable you to participate in these new programs and generate new revenue streams—with no upfront costs, staff increase or capital investments.
Click here to learn more.