Foundation for Chronic Care Management Success

Success with chronic care management begins with an organization committing to launching a program and building its foundation, which includes everything from developing workflows to staff training to identifying the software platform that will help power the program (discussed later in this chapter). But all this work will be naught if patients do not understand and buy into the program — and either withhold their consent to join the CCM program or eventually opt out if they do not recognize the value. In other words, patient education when working to enroll patients in your CCM program is a pivotal factor for success.

One potentially sensitive topic that you will want to ensure is covered before patients are enrolled is their likely expenses for participation in CCM. It often falls to practitioners to educate patients about the overall value of consenting to a chronic care management program. Read on to learn what patients should understand about the personal financial investment that's likely to be required — and why that investment is likely to be very worthwhile.

Chronic Care Management Patient Costs: Justifying Their Investment

For Medicare beneficiaries, CCM is covered under Medicare Part B and is subject to the beneficiary's annual deductible ($233 in 2022) and the 20% coinsurance. For Medicare beneficiaries, CCM is covered under Medicare Part B and is subject to the beneficiary's annual deductible ($233 in 2022) and the 20% coinsurance.

It's important to put financial terms in proper perspective. For example, out-of-pocket expense concerns must be balanced with a greater understanding of the overall value of chronic care management. Specifically, patients might be less reluctant if they know that enrollment and participation are likely to save them money — potentially substantial money — in the long run. Some organizations offer financial assistance programs for those who need it most to help ensure more patients can benefit from chronic care management.

Getting patient buy-in for CCM depends on illustrating tangible reasons that it can be beneficial. Here are the five examples that you can share with patients.

  • Less money spent on hospital bills — If CCM can prevent the need for even just one hospitalization, it will easily justify the price tag. According to Consumer Health Ratings, the cost of a hospital stay for all diagnoses in 2021 is estimated to average over $13,000, excluding physician fees.
  • More efficient management of medications and symptoms — With effective chronic care management, practitioners can pinpoint what medications work and eliminate potentially harmful and unnecessary drugs. Considering that Americans spend more on prescription drugs than anyone else in the world, this can represent significant savings. And with more dialed-in medications and more effective medication management comes better controlled symptoms.
  • Better access to the care team and other resources — Eliminating complex logistics that come with office visits, CCM reduces the likelihood that time-sensitive information will lag. Chronic care management also provides a direct link to the patient's care team, better ensuring that when a care or medication issue or question arises, the patient can receive the support and answers they need directly from a knowledgeable source.
  • Convenience and improved quality of life — A CCM program meets a patient where they are located. Patients can utilize telehealth services, such as remote patient monitoring, through secure platforms that provide current information about care and vitals. This level of coordination allows the healthcare team to make more informed decisions and prompts the patient to be more accountable while reducing the number of trips to the office and amount of time patients need to spend on the road. These clinical gains could easily prevent the need for emergency care and urgent care, and the additional high costs associated with such experiences.
  • Improved coordinated care — According to the University of New Hampshire, duplication of services, such as labs and imaging, wastes as much as $20 billion in healthcare costs annually. Increasing effective care coordination decreases the likelihood of duplicated services.

Creating a Chronic Care Management Patient Brochure

To reinforce the patient education process, practitioners can create educational brochures for distribution during in-person visits. Research has shown they can provide great benefits. While some patients may prefer to research information online, many others still rely on printed materials like brochures. Additionally, a well-designed brochure can be distributed in print and electronically.

Let's examine some key components that should be in an effective chronic care management brochure.

  1. Chronic care management definition — Consider providing a definition for chronic care management — preferably one written in plain language.
  2. Chronic care management eligibility — Educating patients on their potential eligibility may motivate them to inquire about participation in a CCM program and increase their interest in participating.
  3. Time commitment — It's a good idea to demonstrate exactly how CCM can make a patient's life more convenient by reducing trips to the office and granting them access to telehealth services.
  4. Cost of chronic care management — In the brochure, it's wise to explain to patients that CCM is covered by Medicare and typically incurs minimal out-of-pocket cost. Encourage them to talk to a representative from your organization who can give them a more personalized breakdown of estimated costs.
  5. Who is involved — Patients should understand the concept and value of having a chronic care management team who will help them in the program. Explain how having a coordinated care team will function as a support network, allowing patients to get better care when they need it.
  6. How chronic care management helps achieve healthcare goals — Top reasons why patients should enroll in a CCM program include helping them stay healthier and work toward healthcare goals. It's best to spell this out in the brochure. Use concise and clear language that will help them draw the parallels between CCM services and their personal health and wellness. Take into consideration if your patient population needs the information in multiple languages.
  7. Getting started with chronic care management — Help patients overcome the potential obstacle of taking the first step toward enrolling in chronic condition management by clearly communicating what actions they will need to take. It's helpful to anticipate their questions, such as: "Do I need to initiate a conversation with their primary care provider?" and "Is there an onsite program coordinator or patient care advocate, such as a nurse case manager, I should speak to?"

The main takeaway: When creating the content for your brochure, keep the information simple, jargon-free, and easy to follow. Providing just enough information to stimulate interest and facilitate a conversation with you will work best for patients and your program.

Note: If your organization is leveraging CCM as part of a broader comprehensive care management — also known as "virtual care management" — program, this blog post provides some tips on how to explain comprehensive care management to patients.

Chronic Care Management Companies: Choosing the Right Software

The right chronic care management software can make or break a CCM program. It's that simple. And that's why due diligence is essential when researching your CCM software options. Let's look at some of the key qualities to consider when researching and eventually selecting CCM software so that you can make a wise decision.

  1. Security — Cybercrime is a fact of life. An article published by Leftronic revealed that 89% of healthcare providers experienced some sort of data breach within the last two years, and each stolen healthcare record costs healthcare institutions an average of $429. To help avoid the potential bankrupting effects and other damaging fallout from a serious breach, review the security features of the chronic care management software you're considering and ask vendors about the training tactics they use to better ensure data security and protect sensitive patient health and financial information.
  2. Compliance and reporting — With Medicare and commercial payers, coding, billing, and reporting rulescan change with little notice. Make sure your CCM vendor has established procedures to stay current with compliance guidelines, including complying with HIPAA requirements. Look for a program that makes useful reports accessible and data reporting easy.
  3. Integration — To avoid redundancy, find out if the CCM software you're considering integrates with other software solutions, including whether it smoothly integrates with your EHR system. It should include clear dashboards to identify the current status of each patient and save you time, rather than adding duplicate asks to your workflow.
  4. Automation — CCM software should promote efficiency. Look for solutions that automate these kinds of processes:
    • Identifying CCM-eligible patients within your EHR
    • Inputting patient data collected and transmitted via CCM technology directly into patient charts
    • Streamlining billing through intuitive coding processes
  5. Patient churn management — The number of people with chronic conditions who are enrolled in Medicare is expected to balloon. The right chronic disease management software should help you identify these patients as they become eligible for your CCM program. Furthermore, the system should enable you to confirm and document when patients meet the qualifying requirements for CCM

As a valuable bonus, a good chronic care management software program can also support other care management services, such as remote patient monitoring — which is positioned to play a growing role in chronic condition management — and behavioral health integration.

Choosing the right chronic care management software to use and vendor to work with is crucial. Not only does software make the delivery CCM easier, but it also positively affects your return on investment. And the right vendor will collaborate with you to establish and grow your program, provide exceptional customer services, and help you maximize the value and return on investment of your technology purchase.

Of course, another factor that can directly impact your bottom line is your understanding and exception of chronic care management coding and billing.

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