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How to Choose the Right Chronic Care Management Vendor for Your Practice

A Chronic Care Management (CCM) program helps patients with multiple chronic conditions meet wellness goals and engage in their care through ongoing support beyond traditional clinical settings. Practices offering these services benefit from recurring revenue opportunities.

However, a CCM program is often challenging for practices to implement on their own. A successful CCM program requires dedicated enrollment specialists and care managers to handle patient outreach, a care line that operates every hour of every day, and complex CPT billing to ensure maximal reimbursements from CMS. 

Most healthcare providers are already burdened with high patient volumes, extensive administrative work, staffing shortages, and limited resources. They often cannot maintain the communication, documentation, and care coordination required to run a CCM program.

Fortunately, CCM vendors can help you achieve CCM success without the stress of hiring and training new staff and investing in additional infrastructure. CCM vendors bring a wealth of industry experience to your clinical team. They can assist providers with every step of the CCM process, including patient enrollment, archival documentation, and streamlining billing cycles. 

In this article, we will explore the benefits of collaborating with a CCM company to elevate the care you provide to your patients with chronic illnesses. We will also explore how ChartSpan, a national leader in full-service Chronic Care Management programs, partners with practices to transform their care management strategies. 

What services do Chronic Care Management vendors offer?

A well-established CCM vendor should offer practices assistance with every aspect of Chronic Care Management. This includes: 

1. Championing patient marketing and outreach

Many Medicare beneficiaries are unaware of CCM and the numerous benefits that the service can provide them. Before attempting to enroll patients in the program, a CCM vendor will provide eligible patients with educational materials that increase their awareness of the value of CCM.

This could include brochures for in-office distribution, informational emails, printed media, physical mail, voicemails, text messages, and other marketing outreach materials. CCM care managers can also extend personalized calls and welcome packets to patients after they successfully enroll in the program. While the exact materials offered may vary, your CCM vendor should invest in educating patients on your behalf. 

2. Overseeing patient enrollment

Your program’s success relies on robust patient enrollment. This requires thorough knowledge of the benefits CCM offers patients and strong communication skills. CCM vendors should provide your practice with enrollment specialists who are well-versed in articulating the nuances of the program and can maximize patient enrollment. 

You should verify the average enrollment rates of any CCM vendor before engaging in a partnership with them. For example, ChartSpan, an industry-driving CCM vendor, averages 45% enrollment of eligible Medicare beneficiaries (though results will differ). 

3. Managing patient churn

Patient eligibility is dynamic. Patients receiving new chronic illness diagnoses will become eligible for enrollment, and patients who opt out or pass away will phase out of the program. CCM vendors should help you keep this churn positive and grow your program monthly.

When a patient becomes eligible for CCM, enrollment specialists will reach out to educate them and see if they want to join the program. Clinicians will also strive to keep patients in the program by providing extraordinary care through monthly calls and a 24-hour care line. 

4. Handling monthly calls to enrolled patients 

Every patient enrolled in CCM receives a dedicated monthly call from a CCM care manager. The right CCM vendor can provide your practice with compassionate and skilled care managers who can manage a high volume of inbound patient calls while still ensuring each patient receives personalized care and attention during their outbound call.

Care coordinators will check in on recent changes in the patient’s health, ensure they have all their medication refills and specialist appointments arranged, and provide recommendations for community resources if needed. This monthly cadence of individualized communication builds patient loyalty to the program and boosts patient retention. Care managers will further document and archive these records to maintain CMS compliance.  

5. Organizing care coordination, transportation, medication deliveries, and other patient needs

Elevated care coordination is one of the most important elements CCM introduces to your patients. Through their regular communication cadence, care managers can identify potential gaps in care and collaborate with patients to prevent them from emerging. This could include arranging patients’ transportation to scheduled vaccination appointments and cancer screenings, checking on A1C levels or blood pressure readings, and performing mental health and Social Determinants of Health screenings. 

CCM care managers can also assist your enrolled patients with critically important Social Determinants of Health (SDOHs). Patients struggling with financial hardship, housing insecurity, or lack of access to nutritious foods are at risk of exacerbating their chronic illnesses or developing new ones. Care managers can connect patients to valuable local resources, including food banks, community centers, financial assistance programs, clothing closets, support groups, and more. 

6. Maintaining rigorous documentation

CMS requires practices to document all CCM services provided to stay compliant with the program’s rules. This additional record-keeping can be frustrating for providers already drowning in administrative paperwork. A good CCM vendor will eliminate this headache by maintaining accurate, detailed patient records and sharing them with your practice. According to CMS regulations, they will also archive all records for a set period. Through meticulous record-keeping, CCM vendors help you easily submit monthly invoices to CMS and navigate any potential future audits. 

7. Operating a 24/7/365 care line

CCM offers all enrolled patients access to a 24/7 care line daily. Finding the appropriate clinical staff for such an enterprise is a significant and expensive undertaking for an individual clinic, as is building the telephonic infrastructure required to handle incoming call volume.

CCM vendors provide your patients access to a care line staffed by knowledgeable and sensitive professionals. The operators can assist patients with common questions and concerns about medications and symptoms. If the problem demands immediate medical intervention, they can escalate the call to emergency services. 

8. Assisting with monthly CPT billing 

Accurately billing CMS for your CCM services is essential for receiving your hard-earned reimbursements. However, CPT billing is notoriously complex and can consume significant time, especially if your staff is unfamiliar with CCM billing codes and requirements. A quality CCM vendor will assist you at every step of the billing process to ensure you obtain your reimbursements for providing chronic care services to your patients. 

Some CCM vendors, like ChartSpan, may even have proprietary technologies that aid in the billing process. For example, through ChartSpan’s innovative RapidBill™ system, your practice is only responsible for reviewing and submitting monthly bills to CMS. ChartSpan handles the collection of necessary documentation and assigning the relevant CPT codes. 

9. Helping improve practice quality scores 

By successfully implementing CCM at your practice, you will likely see improvement in your quality scores, like Medicare’s Merit-based Incentive Payment System (MIPS) or Overall Hospital Star Ratings. Through CCM, your practice can expand your preventative care offerings, enhance your patient-centered approach to care, reduce hospitalizations and readmission rates, and lower patient costs. These quality improvement measures will aid in boosting your practice's scoring. 

Some CCM vendors, like ChartSpan, provide your practice with dedicated quality improvement specialists to maximize your quality scores. These specialists can help you identify gaps in care and direct patients back to your practice to close those gaps. For example, if a patient is missing recommended adult vaccinations, we can remind them which ones they’re missing and help them schedule an appointment with your practice or a partner pharmacy. ChartSpan includes quality improvement services with its fully managed CCM program at no additional charge.  

10. Ensuring the program’s success through effective integration

CCM implementation can seem daunting, especially when undertaken in isolation. When you partner with an experienced CCM vendor, you access their expertise and resources. Reliable CCM vendors will provide you with detailed assistance at every step of the process, beginning with integrating their CCM platform with your existing EHR.
Your CCM vendor should manage the integration for you, clearly explain how they will pull eligibility data and share it with you for your review, and demonstrate how your practice will receive notifications from the CCM clinical team. They should also walk you through the billing process and how they’ll inform you of patient outcomes and the program’s success. 

Learn more: A Provider’s Guide to Chronic Care Management

Why partner with a vendor for Chronic Care Management?

Partnering with the right Chronic Care Management vendor results in 

• Higher patient enrollment
• Reduced initial overhead costs
• Reliable recurring revenue streams from reimbursements and quality programs* 
• Stronger quality scores
• And improved quality of care and clinical outcomes for patients. 

CCM services demand a significant investment of time, resources, and personnel. Most providers cannot successfully implement the program without hiring and onboarding numerous new staff members, financing sizable infrastructure upgrades to handle incoming and outgoing calls, and redirecting resources to handle documentation, care coordination, and billing. Without effective execution, the program will not achieve the desired patient enrollment or retention, and the reimbursements will not offset the costs incurred. 

When you entrust the day-to-day operations of your CCM program to a reliable vendor, your practice’s patients can reap the program's benefits without your practice taking on added administrative demands. Your practice will then have access to new channels of revenue and improved care delivery for your patients. Through their expertise in the field, experienced CCM vendors encourage higher patient engagement, greater program retention, and consistent practice revenue*.

*Results may vary by provider.

What are the advantages of working with a CCM vendor?

Advantages of working with a reliable vendor include:

• Eliminate hiring additional staff to handle monthly outbound calls, 24/7 care lines, and extra administrative work.
• Improve your CCM program’s enrollment rates by using experienced enrollment specialists.
• Conserve time, energy, and resources by outsourcing CCM’s required telephonic and archival infrastructure.
• Scale your program freely without worrying about the additional labor or financial demands incurred by expanding the program in-house. 
• Open additional revenue streams* with minimal upfront costs and workflow disruptions for your clinical team.
• Access the vendor’s experience and detailed knowledge about CCM, including patient marketing, retention, churn management, billing, and care coordination activities.
• Boost quality scores with the guidance of professional quality improvement specialists.
• Use the vendor’s industry expertise to help establish KPIs, identify growth opportunities, and track performance.
• Elevate the quality of care delivered to your chronically ill patients without overhauling your internal operations.

*Results may vary by provider. 

What are common concerns about working with a CCM vendor?

Some practices have reservations about partnering with an external vendor for their CCM program. Common questions we hear include: 

1. What if patients don’t understand the link between the CCM vendor and the practice? 

A well-run CCM vendor will act as a professional extension of your practice with all enrolled patients. Enrollment specialists can assure patients that the program is sanctioned by your practice and recommended by their provider. 

This connection can be further reinforced by encouraging eligible patients to consider CCM enrollment while at your practice for in-person visits. You can also establish the connection between practice and vendor by having printed CCM materials for patients to review in the waiting room. Well-run CCM companies emphasize clear and continuous communication so patients understand the relationship between the practice and their CCM provider.  

2. Will I lose control of my CCM program by choosing a CCM vendor?

A well-run CCM program should exist to support providers and clinical staff. CCM companies perform duties under the general supervision of providers and healthcare professionals at the practices enlisting their services.

CCM care managers execute day-to-day tasks like documentation, patient calls, and care coordination. They refer patients back to their providers for medical care and follow care plans approved by providers. 

3. Will my reimbursement from Medicare go to the CCM vendor? 

Different CCM vendors use different financial models to charge for their services. Some, like ChartSpan, don’t require up-front fees for their CCM program. Instead, ChartSpan receives a standard fee for every enrolled patient after launching your CCM program. 

This method ensures that your practice is not paying for services that don't result in reimbursements and encourages all participants to maximize patient enrollment, engagement, and retention. Be sure to carefully examine the fee structure of any CCM vendor before entering a partnership with them. 

What are the criteria for evaluating CCM vendors for my practice?

When selecting the right CCM vendor for your practice, evaluate these categories:

• Data management and EHR integration
• Onboarding and training for your clinical staff  
• Telephone systems and documentation archives
• Enrollment services and patient education
• Patient input and satisfaction measurements
• Vendor’s clinical staff training process

Download our white paper to learn more criteria for your practice. 

ChartSpan is a full-service CCM vendor with a wealth of experience delivering high-quality, transformative Chronic Care Management services. We’ve worked with diverse healthcare facilities, from primary care providers to specialty practices to rural clinics. We tailor our strategies to target the specific populations served by each provider we partner with. We collaborate closely with you and your team to ensure maximal success in your CCM program. We’ve compiled a list of critical questions around each category for you to consider as you select the CCM vendor that best fits your needs. 

Learn more: How to Start a CCM Program: A Comprehensive Guide  

Explore ChartSpan’s industry-leading CCM services

ChartSpan is committed to seeing your CCM program flourish. We approach every partnership with enthusiasm and experience, customizing our collaborative approach to meet the needs of your practice. 

We are well prepared to assist you at every stage of CCM, from implementation to monthly maintenance to program expansion. With our highly trained team of in-house enrollment specialists, care managers, quality improvement specialists, and clinical staff, ChartSpan has the tools and personnel to ensure your CCM program grows. From record-keeping to CPT billing assistance, we are adept at handling the administrative tasks demanded by CCM, and we aim to integrate the program into your workflow with minimal disruptions.

ChartSpan follows practice preferences and establishes a strong connection with patients through regular communication and compassionate care coordination. Because of this personal touch, ChartSpan often achieves high enrollment, patient engagement, and retention. We have experience assisting a diverse range of healthcare providers and will tailor our messaging and communication to suit your needs best. Together, we can facilitate positive clinical outcomes for your patients and establish new, reliable revenue channels for your practice*.

*Results may vary by provider. 

Contact us to explore if ChartSpan is the right CCM vendor for you. 

You may also like: 

• The Secrets of Successful Chronic Care Management Training and Onboarding
• The Most Common Chronic Diseases and How to Manage Them With CCM
• 5 Strategies to Improve the Quality of Healthcare