Chronic Care Management (CCM)

Chronic care management improves health and lowers costs.

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What is it Chronic Care Management?

The Centers for Medicare & Medicaid Services (CMS) has determined that the benefits of regular touch points with patients who suffer from two or more chronic conditions decrease the amount of times those patients visit the emergency room and the hospital, which in turn saves CMS money.  For this reason, CMS has for the first time allowed an outside, third party to provide non-face-to-face follow-up care to your patients. This is Chronic Care Management (CCM) and starting in 2019, CMS has approved even more codes to further support the CCM initiative.  

CCM Can Support Your Patients by:

Research shows that having a regular touch point can help patients be more conscious of their health: taking medications, managing fall risk, and other self-management tasks. This help may also encourage patients to stay on track and improve adherence to their treatment plan. This can greatly reduce the chance of ER and hospital admissions, lowering the cost of health care. Roughly 80% of CMS’s cash outlay is triggered by 20% of the population.

Your patients will gain a team of dedicated health care professionals who can help them plan for better health and stay on track for good health. Your patients will be provided servicessuch as monthly check-ins, ready access to their care team, improve patient care coordination, including improved communication and management of care transitions, referrals, and follow-ups.

CCM Can Support Your Practice by:

Improving Care coordination

While CCM can help improve care coordination and health outcomes, you will receive payment specifically in support of your provision of care when our team provides a minimum of 20 minutes of CCM services in a month.

Supporting Patient Connection and Compliance

Healthcare professionals have reported that CCM has helped to improve their efficiency, improve patient satisfaction and compliance, and decrease hospitalization and emergency department visits.

Helping You Sustain and Grow Your Practice

By offering care management activities, CCM can provide you with additional resources to help your practice care for high risk, high needs patients.

What are the benefits of Chronic Care Management?

Benefits for Your Practice:

  • Improved care for patients.
  • Improved patient satisfaction.
  • Increased payments to the practice for the coordinated CCM services provided.

Benefits for Your Patients:

  • By offering CCM services and billing for them under Medicare, eligible patients are provided help from a member of the team who is dedicated to overseeing their care, with whom they regularly interact and know.
  • That team member can help them plan for better health and stay on track with treatments, medication, referrals, and appointments through regular check-ins and reminders.
  • For regular or “non-complex” care, patients may receive at least 20 minutes a month of time dedicated to care coordination services.
  • For “complex” CCM, patients may receive additional time (60 minutes or more) and services.
  • Encouraging patients to use CCM services may offer them the support they need between visits.