Blog

10 Questions to Ask When Choosing a Chronic Care Management Provider

What is Chronic Care Management? What questions should I ask about a CCM program?

Chronic care management (CCM) should be a foundational element for virtually every primary care provider who delivers care to Medicare patients today, especially given the fact that Medicare fee-for-service beneficiaries with multiple chronic conditions account for 93% of total Medicare spending. Providers have an opportunity to change the arc of traditionally debilitating conditions and one of the most prominent contributors to the country’s increasing healthcare costs.

To help providers avoid many costly complications and poor patient outcomes tied to chronic conditions, CMS launched a series of billable codes (#99490) about four years ago. Many providers jumped at the chance to provide better care and support for their patients and generate additional revenue streams. However, four years later, only 46% are offering CCM programs to their patients, according to a recent Porter Research survey. Why is that?

Why have so many providers ignored these programs?

One potential reason is that most physician practices are not equipped with the right resources and systems to properly manage the complexities of profitably managing their CCM populations. According to the Porter Research survey results, 88% of practices are trying to manage the program themselves, using only their EHR system and their own resources.

How do you know what to look for in a CCM partner?

After analyzing those successful programs, the survey finds that the majority of them are outsourcing their CCM programs.

Here are 10 questions you should ask to make sure the partner is the right fit for your practice:

1. What quality measures and performance analytics are in place to monitor the performance of call center representatives and clinical resources that will be interacting with your patients and how will this information be reported each month?
2. How is patient satisfaction measured and reported each month?
3. Does the service provider support direct integration with your EHR system to eliminate manual steps associated with identifying eligible patients and billing? How will that same technology help you manage the large number of patients who “churn-in” and “churn-out” of Medicare each month?
4. What resources are made available to train your physicians and staff members – not only at the time of initial program implementation but also ongoing as new physicians and staff join the practice?
5. How will the program be positioned to your patients and what tactics will be used to secure enrollment conversions in the 50-60% range?
6. What are the historical average patient enrollment rates 30, 90 and 180 days after initial onboarding?
7. How many hours per month does your partner invest training clinical staff and how is this measured and reported?
8. What quality assurance practices are in place to monitor staff performance regularly and how will monthly quality results be reported?
9. Which patient access and social determinant care assistance programs, such as transportation, meals or prescription support, are offered to patients?
10. How does the company support quality performance reporting, such as MIPS, that impact Medicare reimbursement rates?

For more information about how to select the right CCM partner for your organization, or to learn more about how ChartSpan has helped hundreds of providers with their CCM programs, schedule a brief call with one of ChartSpan’s CCM specialists today.