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Effectivity of Chronic Care Management Programs

Thoughtfully designed fee-for-service programs can improve patient outcomes, help drive savings for ACO programs, and save taxpayers money. Medicare’s Chronic Care Management (CCM) program is a beacon among such fee-for-service programs driving Value-Based Care cost reductions. 

What is the focus of CCM?

Chronic Care Management is a virtual preventative care management program designed to prevent the exacerbation of chronic illness among patients. CCM is not case management. CCM is designed to focus on rising-risk patients before they become high utilizers, struggling with high acuity illness. This is accomplished by paying attention to patients in-between provider visits. 

How is CCM accomplished?

This is accomplished by paying attention to patients in-between provider visits. By proactively engaging patients monthly, increased attention is placed on managing the low-level care coordination issues that can perpetuate quickly. Care coordinators focus on preventative screenings, ensuring patients are taking their medications, following the provider’s care instructions, medical appointment adherence, and, increasingly so, focusing on the social determinants that can impact a chronically ill patient. 

What are some examples of real-world improved outcomes?

Ensuring patients have a ride to their upcoming doctor’s appointments, having medications home delivered, and enrolling older patients into programs like YMCA and Silver Sneakers, to manage issues like loneliness or depression, are just some of the examples that are proven to improve patient outcomes. 

Learn more: What is Care Management?

What is the average monthly reimbursement rate?

Medicare values these activities so much, that they reimburse providers on a per patient, per month (pppm), fee-for-service basis. 

• Traditional ambulatory providers average $65 pppm*
•  RHCs and FQHCs average $81 pppm*
  *based on providing non-complex care coordination services to patients.

Those amounts are less than a face-to-face sick care visit, but enough to get the attention of many health systems and practices that care deeply about preventative care, while generating a predictable, recurring revenue stream for doing so.

Where is the data?

Why does Medicare think so highly of CCM programs that they raised reimbursements by 55% in 2022? Simply because Medicare and taxpayers are the big winners when a patient enrolls in a CCM program. Centers for Medicare & Medicaid Services (CMS) claims data shows that if a patient is in the program for at least a year, Medicare achieves $888 per patient, per year in gross savings. Considering the average benchmark of a Medicare patient is $11k+ per year, that’s an impressive cost reduction. 

The data shows (pictured above) that even after paying a provider 59 cents on the dollar in fee-for-service reimbursements for delivering CCM services, taxpayers save 41 cents per patient. Predictably, the cost savings are achieved through a reduction in hospitalizations, readmissions, outpatient services, and skilled nursing facility admissions. 

As impressive as the industry-wide cost savings claims data for CCM appears, it doesn’t begin to keep pace with the cost savings being achieved by ChartSpan. 

ChartSpan leads the CCM industry with mind staggering cost reduction results, as proven through claims data. Consider this; across the claims data of its customer base, the average patient enrolled in a ChartSpan CCM program saves nearly $4,000 per patient, per year. 

In the graphic below, the dark blue color represents patients with two or more chronic conditions enrolled in one of ChartSpan’s customer CCM programs. The light blue represents patients with two or more chronic conditions not enrolled in one of ChartSpan’s customer CCM programs. It’s a true "apples-to-apples" comparison. 

Average Total Cost

CCM Enrolled vs Non-Enrolled, But Eligible Patients

Average Claim Cost Per Patient

• $3,938 per patient annual reduction in total costs when patient enrolled in the CCM program
• 28% reduction in annual costs for Medicare, taxpayers, and patients when a patient is enrolled in a CCM program (despite a significant increase in per patient preventative care E&M encounters) 

As seen below, much of the cost reduction occurred by reducing inpatient and Emergency Department (ED) costs. 

Average Inpatient Costs

CCM Enrolled vs Non-Enrolled, But Eligible Patients

Average Claim Cost Per Patient

• $512 per patient annual reduction in Inpatient costs when patient enrolled in CCM program
• 22% reduction in annual costs for Medicare, taxpayers, and patients when a patient is enrolled in a CCM program

Average Emergency Department Visit Cost

CCM Enrolled vs Non-Enrolled, But Eligible Patients

• $73 per patient annual reduction in ED visit costs when patient enrolled in the CCM program
• 19% reduction in annual costs for Medicare, taxpayers, and patients when a patient is enrolled in a CCM program

Even hospital readmission rates are reduced through CCM programs. 

Average Readmission Rates

The Takeaway: CCM’s Impact on Value

Consider a traditional ambulatory practice running a successful CCM program. It generates $65 pppm in fee-for-service reimbursements. That equates to $780 in annual fees, paid for by taxpayer-funded Medicare, to the provider. If ChartSpan is partnered with that same provider, $3,938 in annual savings is being achieved on behalf of taxpayers during that same annual time period. That generates a net savings of $3,158 pppm for taxpayers. The bottom line, for every dollar spent, CCM generates four dollars in savings.

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