Chronic Care Management
Improve Your Practice and Patient Outcomes
Maximize Your Clinical and Financial Outcomes
Amazing Charts is proud to announce our partnership with Cosán, the industry’s leading healthcare organization creating new pathways to modern aging. Cosán delivers a preventative care coordination tool suite for CCM, BHI & RPM to help providers improve patient outcomes through the use of advanced technologies and expertly designed one-on-one personalized care between office visits.
If your practice exceeds 250 Medicare patients with 2 (or more) chronic conditions, and experiencing one (or more) of the following – it’s time for Preventative Care services.
We can help!
- Our no-risk remote staff augmentation can address bandwidth constraints while reducing your labor costs.
- For patients with chronic conditions, our Preventative Services suite ensures continuity of care, especially in cases of delayed or missed in-person office or telehealth visits.
- By implementing CCM, BHI & RPM, we work in collaboration with you and your staff to proactively engage older adults and high-risk patients, closing the gaps in care, and reducing the chances of hospitalization and readmissions.
- Our trained clinical staff becomes an extension of your practice, capturing real-time patient health information in-between regular office visits. And by leveraging existing billing codes, you are compensated for non-face to face care coordination.
Outsourcing preventative care programs like Chronic Care Management (CCM), Behavioral Health Integration (BHI), and Remote Patient Monitoring (RPM) provides your practice with a comprehensive set of care services – removing the burdens facing many providers today. These CMS validated programs help reduce the cost of care and improve patient engagement, outcomes, and quality measures while increasing your practice revenue with no upfront costs.
Chronic Conditions Present a Lasting Problem
Chronic health conditions account for 90 percent of healthcare spending in the United States. With 60 percent of Americans having a single chronic condition and 40 percent living with two or more, your practice likely sees those with chronic health problems regularly and will in the future.
These long-lasting health concerns can complicate other health conditions. Helping your patients to manage their chronic conditions may lessen their illnesses’ impacts on viral infections, surgery outcomes, or other health concerns in the future.
Chronic conditions impact health for the rest of the patients’ lives. These health concerns include the following:
- Atrial fibrillation
- Chronic COPD
- Cardiovascular conditions
- Alzheimer’s disease
The above problems need focused care that helps the patients affected by them to lead healthier lives. Chronic care management tools facilitate the delivery and coordination of care services beyond the office.
How You Can Help Patients with Chronic Health Conditions
The Centers for Medicare and Medicaid Services (CMS) acknowledges the importance of helping those with two or more chronic conditions that will last at least 12 months. To facilitate practitioners in helping these patients, the CMS adjusted the Medicare Physician Fee Schedule to encourage practitioners to provide extra care to those with chronic conditions.
Chronic care management (CCM) tools help you to track how you care for patients with chronic conditions so your practice can get proper reimbursement. The CCM includes in-office visits and other interactions with patients outside of the clinic.
Through these extra connections with patients who have chronic conditions, you educate the individuals on healthier lifestyles and condition management, follow up on recommended health-related activities, and ensure that patients actively work toward set health goals. Care beyond the clinic can lead to improved outcomes and life quality for patients.
What Chronic Care Management and Other Population Health Modules Can Do for Your Practice and Your Patients
Chronic care management is one part of population health. Other modules that help your practice to track population health include clinical quality measurements (CQM) and care gap analysis.
If you have a significant number of patients with chronic conditions, choosing a CCM module will help you to improve their care and get proper reimbursement. Other population health modules will help your practice in similar ways. CQM ensures that all patients, even those without chronic conditions, have optimum care. Care gap analysis spots areas in which your practice can improve operations and patient care.
When used together, these three population health modules make changing your operations to provide quality-based, patient-centric care simpler. Plus, you get feedback to track your practice’s progress toward improving patient care and operations.
Why Track Chronic Care Management?
Why keep track of your patients’ chronic condition care? In an ideal world, you’d be able to give your patients all the care and attention they need to achieve their healthiest lives possible. However, in the real world you must balance your availability with patient care. A chronic care management module ensures that you keep the balance to ensure that your patients with chronic conditions have the care they need while ensuring that you get compensated for your time. Additionally, you and your patients will enjoy the following benefits when you integrate chronic care management into your practice:
While you want to do everything possible to help your patients, the reality is that time means money to keep your practice going. You don’t have to choose between helping a chronic care patient with extra services and getting paid for treating another patient. Tracking chronic condition patient care ensures that you earn compensation for your time.
Providers of Medicare and Medicaid patients with chronic conditions receive compensation for spending at least 20 minutes monthly per patient receiving CCM care. The only way to get this reimbursement for your time, though, is by tracking your time spent with chronic care patients through a CCM module.
Patients who have chronic conditions with better care coordination, support from their providers, and more personal involvement in their health have better outcomes.
A 2018 systematic review showed that patients who had self-management support showed the greatest improvement in outcomes for patients. Integrating support to help patients self-manage their conditions gives the patient control over their chronic condition and the ability to make positive changes in their health.
Make sure that you properly communicate with third-party payers, such as Medicare, Medicaid, and health insurers. A CCM module gives these entities the data they need to ensure that your practice has compensation for providing high-quality care for patients with chronic conditions.
Don’t let misunderstandings or poorly kept documentation prevent your practice from getting paid. CCM modules collect required data to make the process of connecting with third parties simpler.
Let your patients with chronic health conditions know that they have active roles to play in their health. Patients can take charge of their care between visits when they embrace CCM services. By encouraging patient-directed self-care and involvement in their health, you help them to live healthier. As noted, patients who had support for self-management of chronic conditions showed improved health or outcomes of their conditions.
Chronic condition patients may require emergency room visits or hospital stays to handle serious issues related to their illness. However, with good care at office visits and between visits, patients may have to visit hospitals or emergency rooms less often. Consequently, they have less strain on their lives, spend less money out of pocket for health care, and their insurers spend less on their care.
You don’t have to expand your practice to ensure that you have a steady revenue stream. When you use CCM modules to communicate your patient-centric treatment to insurers, you ensure that you have payments coming in regularly for the care you provide. You don’t need to spend more money to increase the square footage or personnel roster of your practice. CCM modules let you get money from the way that you already operate your practice by taking extra time to care for patients with chronic conditions.
Get Started Today!
Schedule a demo with Cosán