Healthcare organizations can partner with chronic care management companies to develop and implement programs that enable them to appropriately and adequately manage the health needs of patients with chronic conditions. Chronic care management (CCM) companies can help transform healthcare organizations’ capacity to manage and reduce the difficulties encountered in caring for patients with chronic conditions.
From the perspective of healthcare providers, the most important consideration in selecting a chronic care management company is how well the program aligns with the provider’s practice and whether it helps in streamlining the care delivery process while ensuring healthcare personnel engage patients in a care management capacity. The program should help the care personnel in effectively and efficiently documenting their engagement with patients. It is important that the CCM program integrates the existing clinical workflows of the practice.
What are the Services Provided by Chronic Care Management Companies?
Chronic care management companies provide a number of services to organizations to assist them in effectively and adequately addressing the health needs of patients. Chronic care management companies help health organizations develop and implement strategies to improve the ongoing management of the health conditions of patients. These companies also provide staffing and other related services to healthcare organizations.
A well-designed program standardizes workflow to efficiently meet the requirements outlined above.
Common Services Provided
A partner to provide Comprehensive Care Management (CCM) services may offer one or more of the following:
- Â Patient identification and eligibility
- Â Patient enrollment and onboarding
- Â Creation and management of the care plan
- Â Follow-up
- Â Specialist care coordination
- Â Patient education
- Â Self management
- Â Tracking and documenting
- Â Clinical and operational workflows
- Â Billings and collection
- Â Reporting
Why Healthcare Practices Use External CCM Support
Practices engage CCM partners for various reasons including bandwidth, resources, and staffing. The responsibility to manage the care needs of a patient population can be difficult and stressful especially if a patient suffers from multiple chronic conditions.
A CCM partner can assist with care management by freeing staff to focus on more clinical duties. Continuity of care and communication are integral to the success of a CCM program; a CCM partner can provide these services in a manner that complement the clinical services offered by a practice.
Supporting Care Between Office Visits
Integrating RPM with this model is possible and has its own advantages. HHS states that RPM provides a way for patients to transmit health data to their providers using digital devices, allowing providers to collect data on patients in between office visits.
Using this model, consider a patient diagnosed with hypertension and diabetes. This patient may have several medication-related issues and concerns, and her blood pressure may be irregular and hard to manage. Further, this patient may have issues adhering to her treatment plan. With this model, ongoing concerns and issues for this patient may be addressed quickly and the pertinent case management data may be communicated to the care team.
Features to Look for in a CCM Partner
Ideally, the partner’s technology and integrated services would help the practice manage and document its activities, workflow, and case management processes. It should also allow the practice to easily communicate with and educate patients.
EHR Integration and Workflow Compatibility
A system should incorporate methods of communication that match the channels that patients can easily access. This may include mail, telephone outreach, patient portals, and text messaging.
Patient engagement should be bi-directional.This means that the systems should inform practices on the engagement status of patients, and whether patients have acted on activities assigned to them (i.e. readings, reminders and outreach), and therefore, if they need further engagement.
Clinical Escalation Workflows
While automation should not be used to replace clinical judgment, a system should be able to identify situations that require clinical judgment, and route those situations to a clinician.
For example, if a patient has an abnormal reading, the system should be able to determine if further outreach and documentation is needed, and if the situation requires clinical judgment.
Ultimately, the most important consideration in assessing a CCM technology should be the extent to which the system helps operations staff and clinicians effectively manage alerts and notifications. The number of alerts generated by a system should not be the main consideration.
Compliance and Data Security Considerations
The HIPAA Security Rule imposes obligations on covered entities and their business associates to develop and implement security policies to protect electronic protected health information. Therefore, prior to entering into a business associate agreement with a CCM Technology vendor, a covered entity should assess the adequacy of the vendor’s security policies.
Prior to selecting a vendor, practices must look at:
- HIPAA compliance and related legal obligations
- Contracts and amendments
- Access controls
- Data encryption and transport
- Audit controls
- Data storage and retention
- Risk and impact assessments
- Processes for responding to and reporting incidents
HHS further clarifies that business associates of covered entities also have similar obligations under HIPAA and must be safeguarded through business associate agreements. Effective security should integrate and enhance the clinical workflow of the practice, which is why many clinics also review their broader healthcare IT support setup when evaluating a CCM vendor.
Understanding CCM Billing and Documentation
From a business perspective, an effective CCM program should incorporate the necessary clinical and business components to successfully achieve financial viability.
Effective 2020, CMS created several new codes specifically for CCM services. CPT code 99490 defines the initial 20 minutes of clinical staff time directed by a physician or other qualified person. An additional 20 minutes of service is defined by CPT code 99439.
A vendor should assist the practice to document and track CCM activities to the extent that it aids in qualifying for CCM reimbursement. The vendor should not promote activities that increase the risk of violation of the HIPAA limits on patient engagement.
Prior to implementing a CCM program, a practice should verify the most current CMS guidelines and requirements and assess how payer policies may affect program reimbursement. Vendor resources may be out-of-date and increase the risk of violating regulations.
The Role of Technology in Modern CCM Programs
This framework will assist health care organizations to identify and prioritize the essential elements for an effective and efficient Chronic Care Management Program and the role of technology in achieving their goals.
The best model integrates technology with structured clinical pathways. The model allows the clinician to spend less time on data organization and more time addressing the needs of the patient and family.
Choosing a Partner That Supports Long-Term Care
We work to support our client organizations’ efforts to integrate coordination of care for patients and providers. Our clients benefit from a partnership that supports clinical workflow and documents and engages patients in a way that helps care teams focus on the most important work.
When assessing our competitors, clients appreciate the fact that we integrate technology with both patient engagement and remote care in a single integrated system. Our clients evaluate our solutions based on a variety of clinical, business, legal, and technical considerations.
Conclusion
Choosing the right chronic care management company can help healthcare practices improve patient engagement, streamline workflows, and support better coordination of care. The right partner should fit existing clinical processes while providing secure technology, reliable documentation, and effective communication. With the right support, healthcare organizations can manage chronic conditions more efficiently and provide consistent care between office visits.
FAQs
What is a chronic care management company?
A chronic care management company is one that provides services to health care organizations to help them manage care for individuals with chronic conditions. Services may include engagement of patients to implement, change, or support the care plan, documentation, monitoring, integration, and management of communications.
What are the key elements of evaluating a CCM vendor?
When considering a CCM vendor, the elements providers will assess will be similar to assessing an EHR vendor. These may include patient engagement, clinical workflow and integration, reporting and analysis, user access and documentation, and the flexibility and capacity of the solution to scale to meet growing demands.
Is integration of CCM with remote patient monitoring available?
Yes. While RPM and CCM serve different functions, the two may be integrated to help accomplish overall care objectives when clinically appropriate.
What role does technology play in facilitating chronic care management?
With chronic care management, various software applications and technologies may integrate, intercommunicate, and interact with each other to accomplish the objectives of care management.
