Health care management encompasses a variety of medical services and activities that help patients with chronic or complex conditions to manage their health and reduce the likelihood of readmission to a hospital. Care management programs aim to improve patient health, facilitate care coordination between patient and provider, reduce hospital visits, and boost patient engagement.
Health care management programs are designed in partnership with doctors and patients to help reduce readmissions and ensure the ongoing health of the patient. Such programs have seen increased adoption in recent years, and have shown to improve medical outcomes, lower readmission rates, and combat rising healthcare costs.
The Centers for Medicare & Medicaid Services (CMS) recently reported that up to 75% of Medicare hospital readmissions are preventable. According to the report, one in five Medicare enrollees are readmitted following a hospital stay, costing our healthcare system as much as $26 billion per year — and rising.
There is a general interest in improving medical outcomes and reducing healthcare costs from patients, health care providers, health system administrators, government agencies, and patients themselves. As a result, more formal health care management programs are being implemented by medical providers, such as Medicare’s Chronic Care Management (CCM) and Principal Care Management (PCM) programs.
How to Implement a Health Care Management Plan
An increasing number of medical practices are starting to see the potential value and advantages of implementing health care management plans. However, many also state that it can be tough and time-consuming to create and carry out an effective program.
If your practice is thinking about joining a healthcare management plan, here are some tips to make the transition as smooth as possible:
Automate tasks, when possible.
It can be time-consuming and tedious to manually check thousands of practice patients for program eligibility.. Find and implement a service to automate the process, so that the program implementation does not become an expensive drain on time and human resources.
Educate patients about program benefits.
As mandated by law, a medical practice cannot offer or charge for several services in health care management plans without first obtaining patient consent. Although consent can be granted either in writing or verbally, said consent must be recorded in the patient’s file. To free up medical personnel to focus on care obligations and priorities, seek out trained ambassadors to handle education and consent.
Create redundancies and augment staff.
Medical professionals are subject to the same personal circumstances as any other professionals: they take vacation, switch practices, call in sick, and miss work for various reasons. To account for these eventualities, it is advisable to create and document effective systems and processes, such as establishing an outsourced team of trusted medical professionals who can stand in at a moment’s notice to manage the health care management plan administration.
Automate Medicare billing selection and reporting.
To correctly invoice your health care management patients who take part in Medicare’s programs, you need to calculate the time spent and type of care/interaction they received that month. You will then need to cross-reference this information to see which patients are eligible for billing. Manually tracking these activities – or even using a spreadsheet – can be unreliable for management and frustrating for staff. It also raises potential concerns during Medicare audits. Modern software automates nearly every step of the process, from identifying patients who qualify for billing to using programmatic checks that can be overseen manually to make sure nothing is missed.
Find audit support for developing reports.
. You should anticipate having to provide paper trails and documentation of your patients’ treatments and billing in the event of a future Medicare audit. Make a point to review your processes and documentation regularly to ensure it would stand up to close examination in an audit.
Learn How to Launch a Health Care Management Program for Your Practice Today
CircleLink Health provides full-service support for medical practices wanting to implement healthcare management programs.
Their team of trained medical professionals and registered nurse care coaches do the work to integrate into a medical office’s existing workflow, find and enroll eligible patients, manage sensor logistics, create care plans, deliver audit-grade billing reports, and provide necessary Medicare chronic care service logs.
For more information about CircleLink Health’s approach to implementing health care management programs to reduce costs and improve patient outcomes, please visit CircleLinkHealth.com.
