AN OPPORTUNITY OVERLOOKED

CHRONIC CARE MANAGEMENT

Vigilance helps providers develop a CCM program to support improved patient outcomes
and generate new recurring revenue—without increasing staff or upfront costs.
Centers for Medicare & Medicaid Services

PROVIDERS ARE MISSING OUT
ON A NEW REVENUE STREAM

In January 2015, CMS began reimbursing clinicians for providing non-face-to-face care coordination services to Medicare’s sickest beneficiaries. This move offered physician practices an unprecedented opportunity to improve care, better manage populations and boost the bottom line.

Centers for Medicare
and Medicaid Services

PROVIDERS ARE MISSING OUT
ON A NEW REVENUE STREAM

In January 2015, CMS began reimbursing clinicians for providing non-face-to-face care coordination services to Medicare’s sickest beneficiaries. This move offered physician practices an unprecedented opportunity to improve care, better manage populations and boost the bottom line.

IMPROVE CARE

CCM clearly puts the patients’ needs first – which leads to higher patient engagement, and reinforces compliant behaviors and medication management.

BETTER MANAGE POPULATIONS

Chronic care management can be a low-risk way to gain experience and proficiency with population management and value-based reimbursement models.

BOOST THE BOTTOM LINE

The CCM program allows providers to be reimbursed for those services – monthly – which have typically been provided without compensation.

QUALITY OF CARE

WHY PERFORM CHRONIC
CARE MANAGEMENT?

Given its weight in value-based reimbursement, quality should be clinicians’ primary and most immediate focus. Offering chronic care management services is the key to improving quality of care, since two-thirds of Medicare beneficiaries have two or more chronic conditions.

Furthermore, CCM participation hits thirty three measures in the MIPS “Quality Category” and includes twenty two high priority measures. It also fulfills some CPI activities, addresses cost/resource use by decreasing avoidable interventions, and encourages use of EHRs.

IT'S GOOD MEDICINE

— Coordinate care among all physicians, care givers, & services
— Promotes adherence to directives & medication orders
— Health promotion and disease prevention

IT'S A GOOD CLINIC BUSINESS MODEL

— CCM Services: $42.71 per patient per month
— Medicare Investment in Care Management ($15.6B Annually)

IT'S A GOOD MEDICARE BUSINESS MODEL

— 38% Decrease in hospital admissions/readmissions
— 30% Decrease in non-critical ER visits

FINANCIAL IMPLICATIONS

Financially, value-based care coordination can help reduce costs incurred both by the patient and the independent physician. When reimbursement is based on the quality of care rather than the quantity, your emphasis has to be on optimizing each patient visit and ensuring that your patient is knowledgeable, leaving your office with the appropriate treatment plan, and following through with the physicians directives. Otherwise, time and money can be wasted on unnecessary repeat office visits, lab tests, and even hospital admissions.

QUALITY OF CARE

WHY PERFORM
CHRONIC CARE
MANAGEMENT?

Given its weight in value-based reimbursement, quality should be clinicians’ primary and most immediate focus. Offering chronic care management services is the key to improving quality of care, since two-thirds of Medicare beneficiaries have two or more chronic conditions.

Furthermore, CCM participation hits thirty three measures in the MIPS “Quality Category” and includes twenty two high priority measures. It also fulfills some CPI activities, addresses cost/resource use by decreasing avoidable interventions, and encourages use of EHRs.

IT'S GOOD MEDICINE

— Coordinate care among all physicians, care givers, & services
— Promotes adherence to directives & medication orders
— Health promotion and disease prevention

IT'S A GOOD CLINIC BUSINESS MODEL

— CCM Services: $42.71 per patient per month
— Medicare Investment in Care Management ($15.6B Annually)

IT'S A GOOD MEDICARE BUSINESS MODEL

— 38% Decrease in hospital admissions and readmissions
— 30% Decrease in non-critical ER visits

FINANCIAL IMPLICATIONS

Financially, value-based care coordination can help reduce costs incurred both by the patient and the independent physician. When reimbursement is based on the quality of care rather than the quantity, your emphasis has to be on optimizing each patient visit and ensuring that your patient is knowledgeable, leaving your office with the appropriate treatment plan, and following through with the physicians directives. Otherwise, time and money can be wasted on unnecessary repeat office visits, lab tests, and even hospital admissions.

When you consider CMS’ prediction that the number of people with multiple chronic conditions
will reach almost 80 million by 2030, the opportunity for providers is extraordinary.
VIGILANCE HEALTH
When you consider CMS’ prediction that the number of people with multiple chronic conditions will reach almost 80 million by 2030, the opportunity for providers is extraordinary.
VIGILANCE HEALTH
BARRIERS TO CCM

WHY AREN'T PROVIDERS
BILLING FOR CCM (99490) SERVICES?

In a study published in the Annals of Internal Medicine in 2015, it was estimated that healthcare practices that billed CPT code 99490 for chronic care management services provided by non-physician healthcare practitioners (i.e. registered nurses, etc.) could expect an annual practice revenue increase of more than $75,000 if a minimum of 50 percent of eligible patients were enrolled in the program. That’s no small chunk of change.

Vigilance Health has eliminated the following three reasons why healthcare providers have chosen to leave it on the table.

IT'S COMPLICATED

One look at the FAQs page for Medicare’s CCM program shows you that it’s not as straight forward as you might think. There are many rules physicians have to abide by in order to qualify for reimbursement.

IT TAKES TOO MUCH TIME

Since billing for CCM services requires so much attention to detail, including documenting every minute of every phone call, text message, or email to the patient, many physicians don’t have enough time to make sure they’re adhering to all the program guidelines.

TECHNOLOGY BURDEN

Part of ensuring reimbursement from Medicare involves making sure the practice billing for service adheres to the technological requirements put in place by the agency. Certified EHR technology is required, but the reality is EHR’s were not designed for CCM.

BARRIERS TO CCM

WHY AREN'T PROVIDERS
BILLING FOR CCM (99490) SERVICES?

In a study published in the Annals of Internal Medicine in 2015, it was estimated that healthcare practices that billed CPT code 99490 for chronic care management services provided by non-physician healthcare practitioners (i.e. registered nurses, etc.) could expect an annual practice revenue increase of more than $75,000 if a minimum of 50 percent of eligible patients were enrolled in the program. That’s no small chunk of change.

Vigilance Health has eliminated the following three reasons why healthcare providers have chosen to leave it on the table.

IT'S COMPLICATED

One look at the FAQs page for Medicare’s CCM program shows you that it’s not as straight forward as you might think. There are many rules physicians have to abide by in order to qualify for reimbursement.

IT TAKES TOO MUCH TIME

Since billing for CCM services requires so much attention to detail, including documenting every minute of every phone call, text message, or email to the patient, many physicians don’t have enough time to make sure they’re adhering to all the program guidelines.

TECHNOLOGY BURDEN

Part of ensuring reimbursement from Medicare involves making sure the practice billing for service adheres to the technological requirements put in place by the agency. Certified EHR technology is required, but the reality is EHR’s were not designed for CCM.

NEW REVENUE FOR PROVIDERS

THE VIGILANCE HEALTH CHRONIC
CARE MANAGEMENT SOLUTION

We deliver at least 20 minutes of non-face-to-face, chronic care services per month which includes a comprehensive care plan, medication reconciliation, transition of care, care coordination between providers, and 24/7 access to urgent care for patients.

NEW REVENUE FOR PROVIDERS

THE VIGILANCE HEALTH CHRONIC
CARE MANAGEMENT SOLUTION

We deliver at least 20 minutes of non-face-to-face, chronic care services per month which includes a comprehensive care plan, medication reconciliation, transition of care, care coordination between providers, and 24/7 access to urgent care for patients.

THE VIGILANCE TECHNOLOGY

Using our Population Health Platform for Chronic Care Management, we identify CCM 99490 patient/member populations and provide the care plan platform for executing chronic care management. Our care coordinators manage those individuals via this platform which was designed for and supports CPT Code 99490 billing requirements.

THE VIGILANCE TEAM

Our care managers work with providers on executing CCM services to qualifying Medicare members. Hired from the community they serve, our nurses work with providers and support members (patients) with care plan development and execution of chronic care management; including medical and psychosocial behavior management.

SUBJECT MATTER EXPERTS

OUR CARE MANAGERS
ARE EXTENSIVELY TRAINED

Now that healthcare has shifted to value-based reimbursement, the importance of care coordination has been elevated. Even a perfect business model, operational model, or clinical model cannot compensate for uninvested patients who don’t control their clinical conditions. This means new skills are needed for care managers to produce improved results.

Using Healthcare Coaching and Motivational Interviewing techniques, our chronic care management and coordination is conducted with the ultimate view of first; making sure the patients understand the provider’s directives, then we help the patient set plans and goals to ensure adherence to those directives.

HEALTHCARE COACHING

Can be defined as helping patients gain the knowledge, skills, tools and confidence to become active participants in their care so that they can reach their self-identified health goals.

MOTIVATIONAL INTERVIEWING

A gentle form of counseling – extremely effective in fostering change in wide range of health behaviors for all demographics. It works by activating patients own motivation for change and adherence to their Doctor’s directives.

SUBJECT MATTER EXPERTS

OUR CARE MANAGERS
ARE EXTENSIVELY TRAINED

Now that healthcare has shifted to value-based reimbursement, the importance of care coordination has been elevated. Even a perfect business model, operational model, or clinical model cannot compensate for uninvested patients who don’t control their clinical conditions. This means new skills are needed for care managers to produce improved results.

Using Healthcare Coaching and Motivational Interviewing techniques, our chronic care management and coordination is conducted with the ultimate view of first; making sure the patients understand the provider’s directives, then we help the patient set plans and goals to ensure adherence to those directives.

HEALTHCARE COACHING

Can be defined as helping patients gain the knowledge, skills, tools and confidence to become active participants in their care so that they can reach their self-identified health goals.

MOTIVATIONAL INTERVIEWING

A gentle form of counseling – extremely effective in fostering change in wide range of health behaviors for all demographics. It works by activating patients own motivation for change and adherence to their Doctor’s directives.

LET'S START A CONVERSATION.

Vigilance Health is ready to lead you into the future of Value-Based Healthcare. We're here to provide you with more information, answer any questions you may have, and create an effective solution for your value-based care delivery and reimbursement needs.