Rising costs, regulatory requirements, and decreasing reimbursement rates have put immense pressure on healthcare organizations to increase their profitability.
This pressure has led to many organizations searching for new ways to boost revenue and reduce costs. Implementing chronic care management (CCM) programs is an increasingly popular solution due to its ability to drive clinical and financial outcomes.
CCM programs—when executed correctly—can help organizations improve profits by creating new reimbursement opportunities and, if sophisticated outsourced care coaches are used, reduce care coordination time and costs usually borne by in-house staff. Additionally, CCM programs can help improve quality of care, drive better patient outcomes, increase patient engagement, and boost efficiency.
1. Creating New Reimbursement Opportunities
Implementing a CCM program creates new reimbursement opportunities by providing additional billable services your organization may not have previously offered.
Medicare, for example, offers reimbursements for CCM services provided to eligible patients, which includes at least 20 minutes of non-face-to-face care coordination per month. Providers bill for this service using specific CPT codes and receive separate, additional reimbursement.
A CCM program may also offer further billable services, such as medication management, remote patient monitoring, and patient education.
2. Improving Quality of Care and Patient Outcomes
Initiatives such as care coordination, patient education, medication management, lifestyle counseling, and proactive interventions—all a part of a comprehensive CCM program—help healthcare organizations improve their quality of care and patient outcomes.
With quality measures such as Healthcare Effectiveness Data and Information Set (HEDIS), the Medicare Advantage Star Rating system, and the Merit-based Incentive Payment System (MIPS) rising in popularity, improving outcomes and boosting quality goes hand-in-hand with increasing profitability.
3. Reaching Value-Based Care Goals
For organizations working under value-based contracts with payors, CCM is an excellent tool to help them increase their quality of care to reach their care goals and, ultimately, increase their shared savings bonus payments.
For example, after implementing our chronic care management platform, one large group practice saved $4.1k per patient per year on total healthcare costs for Medicare Advantage patients.
4. Increasing Patient Engagement
Engaged and involved patients who take charge of their health realize better outcomes, and as previously discussed, better outcomes lead to increased profitability.
However, organizations often do not regularly engage with patients with chronic conditions, who then may become dissatisfied and seek a different provider. This occurrence is known as leakage and is incredibly costly due to lost revenue.
A robust CCM program helps healthcare organizations bridge that gap, increase patient satisfaction, and create regular, meaningful interactions with those populations who need the most help. Providing timely reminders, goal and progress tracking, and personalized support to patients with chronic conditions not only promotes better patient outcomes and 99% patient satisfaction, but also reduces leakage and no-show rates.
5. Boosting Efficiency
A CCM program, especially when outsourced to an experienced CCM service provider, can streamline processes, reduce costs associated with administrative tasks, and ensure accurate documentation to receive the proper reimbursements quickly.
Our chronic care management solutions require zero upfront work or cost from your organization. Plus, we’re fully staffed by registered nurses (RNs) who you can trust to provide high-quality care, update patient records, and work independently without burdening in-office staff.