The healthcare system has dramatically improved its ability to handle acute illnesses. Bringing successful patient outcomes to emergencies and short-term diseases means that people live longer. However, this longer lifespan increases the chance that someone will eventually encounter a chronic condition like heart disease, cancer, or diabetes. Chronic care management is a growing field in the healthcare community that addresses long-term illnesses.
What is CCM in healthcare?
Managing chronic conditions involves a different set of medical goals than acute care. Many patients will not fully recover from MS, diabetes, or certain cancers. Instead, they will seek to manage these conditions to minimize the impact of a disease on their quality of life.
In 2015, the Centers for Medicare and Medicaid recognized the need to define this new approach to care. They understood that medical practices needed compensation for care outside of regular office visits like medication management and remote communication. By definition, patients qualify for chronic care management services if they have more than one chronic condition that will last at least 12 months or until the patient’s death.
The Growing Need Chronic Care Management Programs
An aging population coupled with lifestyle-related factors like obesity have quickly increased the number of chronic conditions encountered by physicians. In recent years, managing chronic conditions has accounted for two-thirds of the annual healthcare expenses in the United States. The majority of Medicare beneficiaries are dealing with multiple chronic conditions. Therefore, developing meaningful chronic care management programs is critical to the healthcare system.
The Benefits of Chronic Care Management Services
What is CCM in healthcare? It’s a patient-centric approach that promotes an improved quality of life for patients with chronic conditions. This medical understanding brings several benefits.
CCM programs focus on a patient’s overall wellness. Medical staff can take an integrative approach to nutrition, mindfulness, exercise, and medical interventions.
Higher Patient Engagement
A chronic care manager includes the patient in the planning process. Patients are more likely to follow medical advice when they feel they have agency.
CCM plans typically involve fewer office visits but more communication. Remote monitoring tools allow the patient to connect with practice staff regularly.
Fewer ER Visits and Hospitalizations
A focus on well-being reduces the number of ER and hospital visits for patients with chronic conditions. Maintaining their overall health reduces the number of acute medical needs.
Chronic Care Management Codes
As part of the move to CCM services in healthcare, the American Medical Association developed specific chronic care management codes. These new CPT codes offer medical professionals a better way to bill insurance companies for non-face-to-face interactions. For example, CPT code 99490 allows billing for 20 minutes spent coordinating care and forming a care plan.
The cooperative nature of CCM could make billing complex. To avoid this problem, only one qualified medical professional can bill for CCM services for a patient in a given month. CCM billing is limited to care managers like physicians, nurse practitioners, and physician assistants.
Developing a Patient-Centered CCM Program
Medical practices that want to move toward a managed care model for chronic illnesses must do so intentionally. The coordinated approach of CCM will require better lines of communication and a clear organizational structure. CCM also requires patients to take greater responsibility for their health, so practices that adopt a managed care approach will need to develop resources that increase accountability.
The Challenges of Being a Chronic Care Manager
A chronic care management program has the potential to transform long-term patient outcomes. However, adopting this care style can also bring challenges.
The Limits of Patient Engagement
Patients in the early stages of a chronic condition are more likely to follow a health regimen. Medical practices should look for patients who have the best chance of benefiting from a CCM program.
Medical Team Coordination
Conflicting advice within the medical team can lead to confusion for everyone involved. The care team should provide coordinated communication with patients.
Chronic conditions are expensive to manage over time. There is a limit to the out-of-pocket expenses a patient will endure following a care program.
CCM and Community Oncology
Chronic care management is a natural fit for community oncology practices. Many cancers require long-term care that qualifies them as chronic conditions. Patients in these practices will benefit from a care team that offers value-based support during and after treatments. The CCM plan will take other pre-existing conditions into account to prevent complications.
About Horizon Oncology
At Horizon Oncology, our patients are our number one priority. Our providers are known for their excellence in oncology practice and for delivering quality, compassionate care in a delicate atmosphere of trust and concern. Learn more about our comprehensive package of advanced medicine that we personalize to best meet the needs of our patients and their families.