The Future of Chronic Care Management
By: Ellen Price, BS, CCM, PSGT
Healthcare has swiftly changed from something that seemingly should be easy to navigate, to a series of hurdles to clear, and hoops to jump through for both patients and providers alike. Insurance companies have always, and will always, care most about their bottom line, not the patients they serve. It is a sad state of affairs, which has left our aging population struggling to receive the healthcare and medications that they need, as well as to understand the ever increasing complexity and confusing rhetoric that these insurance companies set forth.
Scientific discoveries have made it possible to cure many diseases that were thought to previously be a death-sentence. While these phenomenal advances have helped so many, it has also produced a larger Medicare population than ever before; not to mention the “baby boomers” have reached the age where they qualify for Medicare. Our aging population is larger than ever before, and the way it was being managed was not working.
The Centers for Medicare and Medicaid Services, CMS, recognized this and launched a program in 2015 called Chronic Care Management. When the program was first released, it was very stringent and required a lot of extra time from the providers, which they do not have. CMS has since modified the program so that it is easy for the providers to give quality care to their patients. Since the start of Medicare’s CCM program, Medicare has seen significantly reduced rates of patients being admitted to the hospital due to medical oversight.
Chronic Care Management is a service that is covered by all Medicare Part B insurance providers, as well as Medicare Part B replacement plans. This program was designed to help patients who have multiple chronic illnesses manage their healthcare. CCM Services vary based on individual needs. Patients are assigned a care manager, and this person the patients go to contact for anything they may need assistance with pertaining to their healthcare.
The Care Manager is responsible for building a comprehensive care plan outlining the patients’ individual needs. Chronic Care Managers can answer clinical questions, help schedule appointments, get necessary prior authorizations, assist with insurance appeals, cross check medications for any interactions, and will be in contact with all of those patients’ healthcare providers so that everyone is on the same page. This is called the “Circle of Care”. It should not be up to the patient to navigate the new era of healthcare.
In the next few years, it is my belief that you will see a massive shift in the way healthcare is provided. The beauty of CCM is that it is all done virtually. These are non-face-to-face encounters between office visits to ensure the best quality care overall. When patients visit a doctor’s office or the hospital, they are exposed to unnecessary pathogens that could make matters worse.
My belief and hope is that in the next few years, more commercial insurances will jump on the CCM train. Once that happens, there will not be as much of a need for face-to-face encounters except for the obvious checkups, sick-visits, or necessary procedures. The simple things like, asking questions, reviewing lab results, and managing day to day medical management can be easily done over the phone or even via “Tele-visits”. This will reduce the exposure to dangerous pathogens, and reduce the patient load on the physicians on a daily basis.
I am lucky enough to work for a practice that recognized our patient’s needs, and had the forethought to jump on board. In January of this year, I was working as a medical assistant, providing clinical care to patients with HIV, Chronic Sinusitis, Common Variable Immune Deficiencies, as well as many other chronic conditions. My boss called me on a Thursday afternoon and asked me if I could do some research into the program to see whether or not it would be beneficial to our company. I went home and began to sift through program information as well as the official Medicare policy handbook. I could not help but get excited at all of the new information I found.
The next day, I presented the information that I found to my boss. Much to my surprise, he told me that he wanted me to start the Chronic Care Management department for our company. I have spent the last 6 months working tirelessly to build a department within our company that is based 100% on patient centered care. Patient Centered Care has been proven time and again to have great benefits to both the patient as well as the physicians involved in the Circle of Care. It creates a comprehensive view for all parties involved and it is just nice to know you always have a person to touch base with if you need assistance.
Since the start of our CCM department, I have seen positive changes for many of my patients. I have focused on cultivating trust and building relationships with those enrolled in the program. I have patients that just need me to check in now and again as well as patients that I speak with every day. Some people call me for serious clinical questions, to review lab results, and for help with insurance issues, while others call just to talk because they are lonely. My hope is that my patients feel completely comfortable and confident sharing their most personal information with me. Patients can tell when they are just a number in line, and when someone actually has their best interests at heart. Compassionate, Patient Centered Care should not just be an option for everyone; I believe it is a right.
I am looking forward to seeing the changes unfold, and I am thrilled to say that our company is on-board!