Challenges in Implementing Medicare's Chronic Care Management Program - What to Know

When the Centers for Medicare and Medicaid Services (CMS) introduced its non-face-to-face Chronic Care Management (CCM) service more than four years ago, the goal was to give assistance to more than two-thirds of individuals on Medicare who suffer from multiple conditions. The program was designed for them to receive more coordinated, regular primary care.  The hope was that placing focus on helping patients manage chronic conditions would result in better outcomes for overall population health, enhance individual access to care, and improve patient satisfaction. 

However, even with CCM's many benefits—saving Medicare money, improving health, and generating revenue for health care providers—designing and implementing an effective CCM program proved to be difficult, leading to low program adoption. Take New England, for example. One study found that only 0.65% out of the 1.7 million potentially eligible individuals managed to receive CCM services. 

Why is this the case? Listed below are the common challenges associated with implementing CCM programs and ways on how to solve them. 

Identification of eligible patients

Having to manually check out thousands of practice patients for Medicare or Medicare Advantage insurance and CCM program eligibility is tedious. But by using a care management program like Medistics, health care providers can automate the process to make it easier for them to acquire eligible patients.

Patient education and obtaining consent

Health care providers must first have patient consent—whether verbal or written—before offering or charging for CCM services. And for a consent to qualify, the patient has to be made aware of things like the potential cost-sharing and requirements needed. Coming at a manual solution makes it impossible for a busy practice to enroll patients in CCM. With a tool like Medistics, it would be easier to onboard patients and assign them to a care manager, allowing them to receive the care they need.

Care plan development and adherence

Part of Medicare's guidelines is to create a care plan and protocol to ensure compliance. However, doing these things is time-consuming, and can even be tricky to staff who have no prior training. Medistics can solve this problem by assigning a dedicated care manager to the patient so the physician will no longer have to worry about patient compliance. 

Designing effective systems and process

Patients expect seamless, uninterrupted care. But medical professionals can only do so much at a time. They get sick, go on vacation, switch to a different practice, and miss work for various reasons. The staffing changes can make it hard for patients to receive the care they need. Luckily, a tool like Medistics offers a streamlined approach to care. Since a dedicated care manager will be assigned to your patient, someone will stay on top of their health at all times. There will be less human oversight as well as someone is making sure that things are running smoothly. The care manager will be in charge of managing the patient's daily health, scheduling appointments, obtaining a home health aid, ordering DME supplies, giving regular reminders, and so much more. 

Carrying out a Chronic Care Management program is indeed challenging, but having a platform like Medistics can make it easy. If you want to try it out, get in touch with us today!