Today, if you’re a high performing community health center, these three things are on your priority list, expanding revenue sources to diversify, improving care quality and outcomes and increasing margins to ensure financial viability. Obviously, all three need to be addressed. But looming policy changes have created a future of uncertainty. And for many, that means increased funding pressures, spending cuts and a reduction in much needed expansion efforts. Even if financial stability is restored, health centers operate on thin margins, so they usually have to tackle them one at a time.
But what if you could advance all three simultaneously with no upfront costs?
Staff increases or capital investments? That would be a real advantage. Health centers serve 27 million of our nation’s most vulnerable populations. These patients are at high risk for acute health disparities and typically experienced multiple chronic conditions, including behavioral health disorders. That’s why supporting the overall health and well-being of these patients can be challenging to be successful. Health centers need comprehensive care coordination to address the patient’s clinical, behavioral, financial and psychosocial needs. This is critical to effectively managing their conditions and improving care quality.
But getting patients activated, keeping them engaged in helping them manage their conditions between office visits is resource intensive. And historically, you haven’t been reimbursed for it. Now you can be. Recently, the Centers for Medicare Medicaid Services began new programs that reimburse health centers for providing population health management services, for example, by meeting CMBS requirements. You can bill an average of sixty two dollars per month per patient for care management, one hundred forty five dollars per month for behavioral health management and two hundred and thirty eight dollars for annual wellness visits.
That means if you were to enroll 1000 of your eligible Medicare patients, your health center would see an estimated revenue increase of two million seven hundred twenty two thousand dollars annually and four larger centers with 5000 patients. The increase is more than 13 and a half million. Problem solved, right? Not exactly. These care management services require a combined minimum 80 minutes non face to face clinical staff time per month directed by a physician or other qualified health care professional. In the annual Wellness Visit program requires a 45 to 60 minute health risk assessment prior to their visit.
If you enroll 1000 patients in each of these programs, that’s fourteen thousand hours per year just for the clinical consultations and assessments, plus the additional time for documentation and billing.
Since compliance is essential for reimbursement, clinics may need to invest in technology, staff and training to successfully meet the requirements on their own. This can get costly. But what if you could participate in these programs without the addition of staff or upfront costs? Here’s where we can help. Our care coordination teams, nursing and clinical support staff will perform as an extension of your health center. Eliminating the need for additional technology and staff will talk monthly with your eligible patients about adherence to physician directives and medication orders, developed care plans and set goals.
And we’ll even coordinate care among physicians, caregivers and support services. Using motivational interviewing and health care coaching techniques are highly trained. Care team will empower patients to better manage their conditions and improve outcomes. And they’re absolutely obsessed with patient satisfaction and quality improvement. Meeting these CMBS billing requirements will create new revenue streams with no upfront costs or capital investments. And it will go directly to your bottom line. The vigilance population health service lines are a natural extension of your efforts to improve quality, leverage value based payment models and expand population health strategies.