Launching a Chronic Care Management Program: Part 2

In last week’s post we covered some of the basics and key benefits of CPT code 99490 for Chronic Care Management (CCM). As discussed, there are some inherent challenges associated with the setup, implementation, and management of a CCM program. Among those are:

1. Patient enrollment and retention
2. Creating efficient clinical workflow processes
3. Ensuring adequate staffing

This week, we will focus on patient enrollment and retention. According to a 2012 survey of single specialty practices conducted by MGMA, nearly 22% of patients are covered by Medicare. Of those 22%, almost 69% have 2+ chronic conditions and are eligible for the CCM program. So for a practice with 2,000 unique patients, 300 would be eligible to participate in the program. Obviously, this represents a significant segment of the patient population that would benefit from enhanced care. Additionally, this number represents an average of $151,000 in additional provider revenue.

We established last week the patient requirements for joining the program, including the need for exchange of information and consented agreement. So exactly how do providers identify and reach patients to enroll them? This is a critical sticking point for many practices. To identify eligible patients, the obvious answer is to manually filter through the patient database. Next, providers must somehow communicate with those patients to inform them of, and enroll them in the CCM program. Do providers wait until the next appointment or utilize some manner of outreach program (email, snail mail et al.)? Possibly, however, this represents additional resources that are scarce for most, if not all providers.

Let’s assume that the provider has managed to successfully enroll 75% of all eligible patients in a CCM program. Each patient is now responsible for the $8/month co-pay. While the cost seems inconsequential based on the perceived benefits from the provider’s perspective, the issue of value-for-money is very real for the patient. So, how does the provider ensure patient retention in the program? What type of real or perceived value is the patient actually seeing? This is an issue with most ‘home-brewed’ CCM solutions. Unlike platforms created specifically for CCM programs, the in-house solution lacks the typical mobile UI and value-added features such as lab results, medication information and the ability to communicate directly with the clinical care team and family members.

The team at Orb Health has created a robust, cloud-based platform that not only is plug-and-play for providers (including automated patient enrollment), but also provides patients with critical information right at their fingertips to ensure retention. Learn More.

Next week, we will cover challenge #2 – creating efficient clinical workflow processes.