Blog

If You Don’t Do This, Your Medicare Chronic Care Management Program Will Fail

The inside story of how the country’s largest CCM managed service provider learned a hard lesson 

By Jon-Michial Carter, ChartSpan CEO

If someone were to ask me as the CEO of ChartSpan, "What is the most important operational component in running hundreds of Chronic Care Management (CCM) programs for practices and health systems around the U.S?" the answer would surprise most. The operational importance of recording every single patient phone call is a critical factor in running a successful CCM program.

Managing a quality CCM program requires operational complexity that most underestimate.

The data reconciliation and eligibility verification associated with Medicare patient churn is constant in a CCM program and must be managed well to avoid negative Net Patient Churn. The level of patient education required to achieve respectable program enrollment conversion rates requires dedicated and experienced patient marketing resources. The resources must have the ability to produce a steady stream of electronic and printed patient educational materials.

After you have effectively managed your patient data, churn, eligibility, and education, you move to the patient enrollment stage of a CCM program.

The most difficult part of running a CCM program is enrolling patients. Making sure you have each patient’s accurate copay and demographic data and then compelling them that the value they get in return for their monthly coinsurance obligation takes a skilled subject matter expert. Pro tip: Don’t expect your providers or clinical staff to do the enrollment, they hate it, and usually aren’t very good at it.

It’s the enrollment of a patient into a CCM program that causes the most friction. In the early days of ChartSpan, we never imagined the need to record an enrollment call with a patient. Simply ensuring you informed the patient about the program in a compliant way and received their consent to enroll seemed adequate.

Frankly, an enterprise level telephony recording system cost hundreds of thousands of dollars, and we didn't have the profit margins to afford it. But we learned a hard, ugly lesson; patients tend to forget about the consent they gave and the value they received from the program when a bill arrives in the mail. While that’s not an unusual phenomenon for providers who deliver healthcare services, it caused enormous problems between us and the practices we worked for. Patients would tell providers, "I never agreed to enroll in the program," or, "I was never told there was a copay," or "No one ever called me to get my permission." You can guess what happened next. We spent endless cycles assuring clients we properly consented their patients before enrolling them. At the end of the day, it came down to our word versus their patients…a terrible position to put ourselves in. 

An even larger challenge in running a CCM program is earning the trust of a provider regarding your clinical abilities. Most providers have spent years building their practice and patient relationships. They aren’t interested in partnering with care coordinators in which they don’t know the competency of or in which they do not have a transparent way to review their performance. 

The lesson was learned, it became painfully clear to us at ChartSpan that investing in technology and processes that allowed us to record EVERY patient enrollment and clinical call would be vital to our success and in building strong relationships with the providers in which we worked for. 

We tried but failed to find an off-the-shelf telephony system that was customizable for a CCM program. Already a strong Amazon Web Services (AWS) customer, we scrutinized Amazon Connect, an AWV cloud-based telephony product and fell in love. It allowed us to customize the technology to our needs and, most of all, it was extremely dependable. What happened next was amazing!  

Our telephony system allowed us to securely send a patient call to a client within seconds of them requesting it. Now, when a patient made a claim that they didn’t know they had a financial obligation, the client simply listened to the call and knew the patient’s claim was not accurate. Clients quickly learned to trust that we were enrolling patients in a fully compliant manner. 

The call recordings also strengthened our relationships with providers who might have questions about a particular clinical encounter. They simply requested any patient interaction that may have occurred and were able to listen to the exchange between the clinician and the patient.

This built confidence in the eyes of providers that their patients were receiving quality clinical services and that clinical protocols were being followed.

Something else happened that was very unexpected. The recorded calls allowed us to improve our Quality Assurance scrutiny and closely examine the performance of our Clinicians and Enrollment Specialists. We built quality rubrics that allowed us to listen to a call and audit the performance of each clinician. Doing so allowed us to identify our very best staff and those that needed coaching.

I’m fond of telling a provider who is considering hiring ChartSpan, "Can you imagine if I followed you into your patient waiting room with a camera and recorded your patient appointment? 

Then, can you imagine if I sat you down after the patient encounter and gave you a grade and feedback on your performance and bedside manner?  And then, could you imagine if I gave you feedback regarding areas of your performance in which I expect to see improvement if you want to continue practicing medicine at this practice?

Because that’s what every single clinician at ChartSpan must go through, on a weekly basis, to be able to work for you and deliver care services to your patients."  After some nervous laughter, providers realize very quickly how obsessed we are with the clinical quality of our services and the importance of recording patient calls.