For many of the 117 million Americans who have chronic health conditions, Chronic Care Management (CCM) can literally make the difference between life and death. It can also greatly impact the quality of life patients experience as they adjust to living with a condition like diabetes, arthritis, Crohn’s disease, or COPD. Simple actions like calling to check on a patient or sending them a follow-up email helps improve overall outcomes in three ways:

  • It reminds patients of what they are supposed to do.
  • It gives them an opportunity to ask questions.
  • It communicates that your medical staff cares and wants to help.

Unfortunately, many medical providers who begin to implement a Chronic Care Management program don’t see much financial return on their investment.

If that’s true for you, the good news is that it doesn’t have to be that way. It is completely reasonable to expect that you can boost profit for your practice by seeking reimbursement for chronic care management while also improving outcomes for your patients.

But before we talk about how to do that, let’s start with why your program isn’t as profitable as it could be.

Why Hasn’t Your Chronic Care Management Program Gained Traction?

Chronic Care Management demands a significant commitment of time and resources, and when you also have to document that time for submission to Medicare, the investment sometimes becomes unsustainable. Maybe you tried to implement a program, but your staff didn’t have time to keep up with it or enrollment was poor. Perhaps the billing requirements seemed too complicated or the program never made much money.

If those scenarios describe your experience, you’re in good company. Many Chronic Care Management reimbursement programs fail to show a profit for these three reasons:

  • Overworked Internal Staff – Effective Chronic Care Management programs require significant time investments from your staff. Each patient in the program must receive 20 minutes of non-face-to-face interaction every month in the form of phone calls or emails, and staff members must document that time as well as any other time spent arranging referrals, reviewing labs, or speaking to home health nurses. Reimbursement requires monthly documentation and billing, and staff members will also need to invest time in patient education to encourage enrollment in the program. For many practices, it’s too much added burden for internal staff members who may already be overworked.
  • Low Enrollment – To receive reimbursement from Medicare, practices must enroll patients in the CCM program and document their consent. This can be a significant hurdle, especially since a co-pay is required. Patients may not want to pay an added fee or they may distrust a new program that extends beyond the scope of expected care.
  • Inadequate Technology – Medicare’s chronic care management reimbursement program requires participating practices to provide 24/7 access to patient care plans using an electronic medical records (EMR) system. The system must document the specific information required for reimbursement and must be able to incorporate information from other providers. For some practices, the cost of investing in adequate technology may seem to outweigh the financial benefits.

How Can You Create a Profitable Program Without Overburdening Your Staff?

But it’s not all bad news. In 2017, Medicare relaxed some of the requirements for reimbursement, making it easier to document and submit the required information and reducing the program’s complexity.

But what if your practice is still struggling to create a profitable program? How can you turn the tables without overburdening your staff or creating unnecessary frustration?

  1. Educate Patients – Many patients simply don’t understand the benefits of chronic care management. Maybe they think they don’t need additional oversight once they leave the hospital or they don’t understand how the program will affect them. Educating them about benefits like receiving 24/7 access to their care plans, improving long-term health, and reducing the need for in-person appointments can encourage participation.
  2. Launch a Strategic Enrollment Program – A second reason for low participation is that patients don’t know about the program. You can use strategies like brochures, a poster in the waiting room, and verbal explanations to promote awareness and encourage patients to enroll.
  3. Use a Dedicated Staff Member – Many practices find that the extra paperwork and phone calls required for Medicare reimbursement become too labor intensive for their staff. One way around this problem is to hire a staff member dedicated to managing the program. This has the double benefit of increasing the amount of time available to invest and removing the added workload from staff members whose plates are already full.

For many practices, the most efficient and cost-effective way to create a profitable chronic care management program is to partner with a third-party management company like HealthXL®. Our goal is to support patients and manage program details so you are free to focus on your medical practice, not on paperwork.